The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study

Alcolea-Medina, Adela; Snell, Luke B; Alder, Christopher; Charalampous, Themoula; Williams, Tom; Group, Synnovis Microbiology Laboratory; Tan, Mark; Al-Yaakoubi, Noor; Humayun, Gul; Newsholme, William; Goldenberg, Simon; Nebbia, Gaia; Neil, Stuart; Batra, Rahul; Edgeworth, Jonathan D

doi:10.1016/j.cmi.2023.03.001

Cited by 36 publications

(26 citation statements)

References 8 publications

(11 reference statements)

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“…Even though these infections result in about 500,000 deaths annually worldwide, imposing a substantial economic burden [11, 41], data on the incidence of iGAS clinical manifestations remain scarce. At the University Hospital of Zurich, a threefold increase of the number of invasive and non-invasive GAS strains was reported since December 2022 compared to the pre-pandemic years, which aligns with the reports of other countries [6, 9]. Within our study, the most prevalent diagnosis was SSTI, in line with findings from a study conducted in New Zealand [42], followed by primary bacteremia and pneumonia.…”

Section: Discussionsupporting

confidence: 91%

“…While we found a large emm1/ST28 cluster, including the reference strains (refMIuk, ref5005 and ref5448), the absence of outbreak characteristics, such as clustered cases in a specific geographical region and a high genetic relatedness within potential transmission chains, suggests that the strains of the current resurgence were part of the diversity already circulating before the COVID-19 pandemic. The emm1/ST28 genotype has been commonly reported causing iGAS infections [34], consistently indicating its dominance over the years [9,10,35,36]. Accordingly, we observed that in our cohort emm1/ST28 was the predominant variant, present in most patients (5/7) who died from an iGAS infection.…”

Section: Discussionsupporting

confidence: 78%

“…Our findings point out that the recent upsurge does not arise from pathogen-related factors, prompting further exploration of alternative causes, as proposed in prior studies [6,9,10,44].…”

Section: Discussionsupporting

confidence: 70%

“…Also in Switzerland, since November 2022, a fourfold increase of the registered iGAS infections in children, including four deaths, has been reported compared to the pre-COVID-19 pandemic era [8]. So far, there is no evidence for the emergence of a more virulent clone [9, 10]. In the United Kingdom the pre-pandemic predominant M1uk clone was detected in the majority of the GAS strains isolated during the December 2022 outbreak [9].…”

Section: Introductionmentioning

confidence: 99%

“…So far, there is no evidence for the emergence of a more virulent clone [9, 10]. In the United Kingdom the pre-pandemic predominant M1uk clone was detected in the majority of the GAS strains isolated during the December 2022 outbreak [9]. The causes of the resurgence of iGAS remain somewhat elusive.…”

Section: Introductionmentioning

confidence: 99%

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Molecular epidemiology of invasive Group A Streptococcal infections before and after the COVID-19 pandemic in Switzerland

Andrianaki,

Franz,

Andreoni

et al. 2024

Preprint

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Group A Streptococcus (GAS, aka Streptococcus pyogenes) poses a significant public health concern, causing a diverse spectrum of infections with high mortality rates. Following the COVID-19 pandemic, a resurgence of invasive GAS (iGAS) infections has been documented, necessitating efficient outbreak detection methods. Whole genome sequencing (WGS) serves as the gold standard for GAS molecular typing, albeit constrained by time and costs. This study aimed to characterize the postpandemic increased prevalence of iGAS on the molecular epidemiological level in order to assess whether new, more virulent variants have emerged, as well as to assess the performance of the rapid and cost-effective Fourier-transform infrared (FTIR) spectroscopy as an alternative to WGS for detecting and characterizing GAS transmission routes. A total of 66 iGAS strains isolated from nine Swiss hospitals during the COVID-19 post-pandemic increased GAS prevalence were evaluated and compared to 15 strains collected before and 12 during the COVID-19 pandemic. FT-IR measurements and WGS were conducted for network analysis. Demographic, clinical, and epidemiological data were collected. Skin and soft tissue infection was the most common diagnosis, followed by primary bacteremia and pneumonia. Viral co-infections were found in 25% of cases and were significantly associated with more severe disease requiring intensive care unit admission. WGS analysis did not reveal emerging GAS genetic distinct variants after the COVID-19 pandemic, indicating the absence of a pandemic-induced shift. FT-IR spectroscopy exhibited limitations in differentiating genetically distant GAS strains, yielding poor overlap with WGS-derived clusters. The emm1/ST28 gebotype was predominant in our cohort and was associated with five of the seven deaths recorded, in accordance with the molecular epidemiological data before the pandemic. Additionally, no notable shift in antibiotic susceptibility patterns was observed. Our data suggest that mainly non-pathogen related factors contributed to the recent increased prevalence of iGAS.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 78%

“…Our findings point out that the recent upsurge does not arise from pathogen-related factors, prompting further exploration of alternative causes, as proposed in prior studies [6,9,10,44].…”

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Molecular epidemiology of invasive Group A Streptococcal infections before and after the COVID-19 pandemic in Switzerland

Andrianaki,

Franz,

Andreoni

et al. 2024

Preprint

View full text Add to dashboard Cite

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Epidemiology and emm types among group A streptococcal pharyngitis in Finland: a prospective laboratory-based study

Virolainen,

Gröndahl-Yli-Hannuksela,

Rantakokko-Jalava

et al. 2023

Eur J Clin Microbiol Infect Dis

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Purpose Streptococcus pyogenes (mostly termed group A Streptococcus - GAS) is the most important bacterial causative of pharyngitis. However, epidemiology of GAS pharyngitis is not widely established. This study describes GAS pharyngitis cases and emm-type distribution in a prospective study covering over 2 years in two Hospital Districts in Finland. Methods A prospective, systematic collection of GAS pharyngitis isolates was conducted between March 2018 and December 2020 in two large Hospital Districts in Finland. Patient characteristics (age, gender) were included if available. All GAS isolates collected were emm typed. Results Altogether 1320 GAS pharyngitis strains were collected, 904 in the Hospital District 1 (HD1) and 416 in Hospital District 2 (HD2). In HD1, age and gender data were available. Females were overrepresented (58% of all cases). In addition, the age and gender distributions were noted to be significantly different (p < 0.0001) with females having a more uniform distribution until age of 40. emm28 was common among the age group of 20–29-year-olds and emm89 in children under 10 years of age, respectively. In HD1, most of the isolates were collected during winter and autumn months. Significant differences by season in the frequency of emm12, emm89, emm75 and group of “others” were observed. Conclusion Age distribution among GAS pharyngitis cases was significantly different between genders (p < 0.0001). In addition, age group specific and seasonal variations in emm GAS types causing the disease were observed. These findings warrant further investigation, especially for understanding population-based spread of GAS even in more detail.

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Preadmission course and management of severe pediatric group A streptococcal infections during the 2022–2023 outbreak: a single-center experience

Schöbi,

Duppenthaler,

Horn

et al. 2024

Infection

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Purpose The massive increase of infections with Group A Streptococcus (GAS) in 2022–2023 coincided in Switzerland with a change of the recommendations for the management of GAS pharyngitis. Therefore, the objective of the present study was to investigate whether the clinical manifestations and management before hospitalization for GAS infection differed in 2022–2023 compared with 2013–2022. Methods Retrospective study of GAS infections requiring hospitalization in patients below 16 years. Preadmission illness (modified McIsaac score), oral antibiotic use, and outcome in 2022–2023 were compared with 2013–2022. Time series were compared with surveillance data for respiratory viruses. Results In 2022–2023, the median modified McIsaac score was lower (2 [IQR 2–3] vs. 3 [IQR 2–4], p = < 0.0001) and the duration of preadmission illness was longer (4 days [3–7] vs. 3 [2–6], p = 0.004) than in 2013–2022. In both periods, withholding of preadmission oral antibiotics despite a modified McIsaac score ≥ 3 (12% vs. 18%, n.s.) or ≥ 4 (2.4% vs. 10.0%, p = 0.027) was rare. Respiratory disease, skeletal/muscle infection, and invasive GAS disease were significantly more frequent in 2022–2023, but there were no differences in clinical outcome. The time course of GAS cases in 2022–2023 coincided with the activity of influenza A/B. Conclusion We found no evidence supporting the hypothesis that the 2022–2023 GAS outbreak was associated with a change in preadmission management possibly induced by the new recommendation for GAS pharyngitis. However, clinical manifestations before admission and comparative examination of time-series strongly suggest that viral co-circulation played an important role in this outbreak.

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The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study

Cited by 36 publications

References 8 publications

Molecular epidemiology of invasive Group A Streptococcal infections before and after the COVID-19 pandemic in Switzerland

Molecular epidemiology of invasive Group A Streptococcal infections before and after the COVID-19 pandemic in Switzerland

Epidemiology and emm types among group A streptococcal pharyngitis in Finland: a prospective laboratory-based study

Preadmission course and management of severe pediatric group A streptococcal infections during the 2022–2023 outbreak: a single-center experience

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