Increase in Invasive Group a Streptococcal Infections in Children in the Netherlands, A Survey Among 7 Hospitals in 2022

Abstract

Following an increase in notifiable invasive group A streptococcal (iGAS) infections in the Netherlands, we conducted a survey among 7 hospitals. Pediatric iGAS case numbers were 2-fold higher between July 2021 and June 2022 versus pre-COVID-19. A sharp increase occurred early 2022, most pronounced in <5 years old and for diagnoses empyema and necrotizing fasciitis. This recent pediatric iGAS surge warrants investigation and vigilance.

Group A Streptococcal Meningitis With the M1UK Variant in the Netherlands

“…1,2 In several European countries and the US, an increase of invasive group A streptococcal infections has been observed since September 2022, with shifts in affected age groups and clinical presentations relative to historic observations. 3,4 We performed an epidemiological assessment of S pyogenes meningitis cases in the Netherlands, defined by culture-positive cerebrospinal fluid (CSF), using more than 40 years of national bacteriological surveillance data.Methods | Active microbiological surveillance and molecular epidemiology of all-cause bacterial meningitis, including S pyogenes, is performed by the Netherlands Reference Laboratory for Bacterial Meningitis (NRLBM). We analyzed S pyogenes isolates cultured from CSF between January 1, 1982, and March 13, 2023.…”

“…It is important to understand historical clinician prescribing patterns prior to these policy changes to track the specific effects going forward. Prior research mainly relies on DATA-waiver status 4 or prescription data 5 alone to estimate the workforce, leading to likely overestimates. To address these limitations, this study examined trends in DATA-waivered clinicians' active participation in prescribing buprenorphine, overall and by patient limits, between January 2017 and May 2021.…”

“…A rare but severe invasive group A streptococcal infection is meningitis, which has an estimated incidence in adults of 0.2 per 1 million individuals per year . In several European countries and the US, an increase of invasive group A streptococcal infections has been observed since September 2022, with shifts in affected age groups and clinical presentations relative to historic observations . We performed an epidemiological assessment of S pyogenes meningitis cases in the Netherlands, defined by culture-positive cerebrospinal fluid (CSF), using more than 40 years of national bacteriological surveillance data.…”

Group A streptococcal meningitis with the M1UKvariant in the Netherlands

“…A rare but severe disease manifestation of iGAS is meningitis, which has an estimated incidence in adults of 0.2 per 1,000,000 persons per year 1,2 . Several European countries as well as the United States have observed an increase of iGAS infections in the past months, with shifts in affected age groups and clinical presentations relative to historic observations 3,4 . Here we performed an epidemiological assessment of S. pyogenes meningitis cases, defined by culture-positive cerebrospinal fluid (CSF), using over 40 years of national bacteriological surveillance data.…”

Novelemm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022

“…An upsurge in both notifiable and non-notifiable iGAS infections was observed in the Netherlands compared to pre-COVID-19 levels in spring 2022, shortly after COVID-19-related restrictions were lifted. Alarmingly, this increase disproportionally affected children under 6 years of age 1,2 . Changes or shifts in dominance of emm -types, which are detected through bacteriological surveillance, may indicate changes in virulence or transmission within the S. pyogenes population.…”