WHO Warns of Increase in Strep A Infections Amongst Children in Europe
The World Health Organization in Europe has issued a statement requesting that European countries remain vigilant given the rise in the number of cases of invasive Group A streptococcal (iGAS) disease among children under 10 years of age. A number of countries in the European region including France, Ireland, the Netherlands, Spain, Sweden and the United Kingdom have indicated an increase in 2022, particularly since September.
Although investigations are ongoing, early typing data suggests that the surge of cases is not related to a specific or new strain, nor an increase in antibiotic resistance of GAS.
In rare cases, GAS bacteria can also cause a severe, life-threatening infection known as iGAS disease, which may manifest as bacteraemia, pneumonia, or skin and bone infection (cellulitis, osteomyelitis, necrotizing fasciitis). Children with viral infections such as varicella (chickenpox) or influenza are at higher risk of developing iGAS disease.
WHO/Europe and the European Centre for Disease Prevention and Control (ECDC) currently assess the risk for the general population posed by iGAS infection as low.
Since September, several deaths associated with iGAS disease in children under 10 have also been reported, including from France, Ireland, Spain and the United Kingdom. In France and the United Kingdom, the number of iGAS cases observed in children has been several-fold higher than pre-pandemic levels for the equivalent period of time.
The observed increases reported to WHO/Europe and the ECDC have followed a period of reduced incidence of infections with Group A Streptococcus during the COVID-19 pandemic.
According to the WHO it is likely that the increase in cases of iGAS disease in children is also associated with the recent increased circulation of respiratory viruses, including seasonal influenza and respiratory syncytial virus, as coinfection of viruses with GAS may increase the risk of iGAS disease.
Symptoms of the disease include sore throat, headache and fever, along with a fine, red rash (scarlet fever). GAS pharyngitis is diagnosed by rapid antigen detection test and/or bacterial culture, and is treated with antibiotics and supportive care.
Reducing the transmission of GAS will help to reduce the risk of severe iGAS infection. Early recognition of iGAS disease and prompt initiation of specific and supportive therapy for patients can be life-saving.
WHO Regional Director for Europe Dr. Hans Henri P. Kluge calls on countries to ‘increase vigilance to iGAS cases, especially when respiratory viruses are widely circulating in children’. ECDC Director Dr. Andrea Ammon notes that ‘iGAS cases can be managed easily if detected in a timely manner’.
WHO/Europe and ECDC is encouraging countries to undertake public health messaging to parents and guardians of young children. iGAS infections can present initially with non-specific symptoms such as fever, general tiredness, loss of appetite but, particularly in children, they can rapidly progress to severe disease. Parents and guardians should therefore be aware of worrisome symptoms and seek clinical advice and assessment if their child’s health is not improving.