Invasive Group A Streptococcal Infection in Children, 1992-2023
Notice bibliographique
Résumé
Importance: The resurgence of invasive group A streptococcal (iGAS) infections and progress in GAS vaccine development emphasize the importance of understanding current trends in the epidemiology of iGAS. Objective: To describe the epidemiology of pediatric iGAS over a 32-year period. Design, Setting, and Participants: This case series uses population-based surveillance data for iGAS in Toronto and Peel Region, Canada, including emm typing from Canada's National Microbiology Laboratory and population data from Statistics Canada. All children (age <18 years) with iGAS from January 1, 1992, to December 31, 2023, were included. Data were analyzed from July 15, 2023, to September 1, 2024. Main Outcomes and Measures: Outcomes of interest were disease incidence over time and by age; variation in clinical presentation, disease severity, outcomes and infecting emm types; and antimicrobial resistance. Results: Overall, 498 iGAS cases (300 [60.2%] male; median [IQR] age, 5.1 [2.7-8.6] years) occurred, including 151 (30.7%) in children with comorbidities. The most common presentations were soft tissue infection (140 cases [28.1%]) and bacteremia without focus (131 cases [26.3%]). iGAS incidence increased from 1.8 events per 100 000 population per year in 1992 to 2011 to 2.4 events per 100 000 population per year in 2012 to 2019 (incidence rate ratio, 1.3 [95% CI, 1.1-1.6]), with the increase occurring in GAS infections of the respiratory tract. Incidence declined to 1.2 events per 100 000 population per year in 2020 and 0.5 events per 100 000 population per year in 2021 before increasing to 6.0 events per 100 000 population per year in 2023. In 2022 to 2023, 18 of 56 children with iGAS (32.0%) had a viral respiratory coinfection. Varicella-associated iGAS cases declined from 23 of 137 children (16.8%) in 1992 to 2001 to 2 of 223 children (0.9%) in 2012 to 2023 (P < .001), after routine varicella vaccination implementation in 2004. Streptococcal toxic shock syndrome occurred in 29 children (5.8%), necrotizing fasciitis in 12 children (2.4%); 10 children (2.0%) died. The most common emm types were emm1 (182 of 471 isolates [38.6%]), emm12 (75 isolates [15.9%]), and emm4 (31 isolates [6.6%]). The M1UK subtype was first identified in 2019 and comprised 32 of 46 emm1 isolates (70.0%) from 2019 to 2023. Compared with other emm types, emm1 was more likely to be associated with pneumonia (odds ratio [OR], 1.99 [95% CI, 1.16-3.40]), bone and joint infections (OR, 1.70 [95% CI, 1.08-2.68]), and intensive care unit admission (OR, 1.67 [95% CI, 1.03-2.68]); emm4 was more likely to be associated with bacteremia without focus (OR, 6.10 [95% CI, 2.83-13.16]). Overall, 437 isolates (92.8%) were of emm types included in the 30-valent GAS vaccine. Conclusions and Relevance: This case series found that pediatric iGAS incidence increased in south-central Ontario prior to and after the COVID-19 pandemic in association with increased iGAS infections of the respiratory tract. Respiratory viral coinfections were common. Different emm types were associated with differing presentations and severity.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».