High morbidity and mortality in children with invasive lower respiratory tract group A streptococcal infection in England, winter 2022
Abstract
OBJECTIVES
To describe the epidemiological and clinical characteristics of children with invasive group A Streptococcus (iGAS) infection and severe GAS-associated lower respiratory tract infections (including empyema) [LRTIs] identified in England in late 2022, supporting earlier recognition and informing pre-hospital admission clinical decision and public health response.
STUDY DESIGN
Case series analysis.
METHODS
LRTI iGAS cases in children aged <15y in England reported between October 01 and December 21, 2022, were identified using laboratory data (GAS detected in LRT specimens) and notifications by clinicians. Symptoms, diagnoses, healthcare interactions, and outcomes were described based on case management notes, the National Child Mortality Database, and the national Emergency Care Dataset (ECDS).
RESULTS
Across England, 147 paediatric cases of LRTI iGAS were reported, 52% male and with a median age of four (IQR 2-6) years. Most reported symptoms were fever (75%; n = 90) and cough (50%; n = 60). Half (50%, n = 74) had a confirmed respiratory viral coinfection. Over three-quarters (77%, n = 113) attended an emergency department and 25% died (n = 37/147), with a median of four days from symptom onset to death. Over half of these deaths (n = 21/37) occurred in the community, with several (n = 6) cases having rapid deterioration recorded. Of cases who died, 81% (n = 21/26) had their GAS-positive sample taken shortly before death or post-mortem.
CONCLUSIONS
Viral-like…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 113 participants or records.
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