Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (2024)

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  • Brechje de Gier1Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (1), Jan van de Kassteele1, Liselotte van Asten1, Annelot F Schoffelen1, ISIS-AR study group2, Mariette Hooiveld3, Margreet JM te Wierik1, Nina M van Sorge4,5, Hester E de Melker1

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    Affiliations:

    1Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

    2The members of the ISIS-AR study group are listed under Collaborators.

    3Nivel, Utrecht, the Netherlands

    4Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Center location AMC, Amsterdam, the Netherlands

    5Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Center location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands

    Correspondence:

    Brechje de Gier

    brechje.de.gierrivm.nl

  • View Collaborators

    Members of the ISIS-AR study group:JWT Cohen Stuart,DC Melles,K van Dijk,A Alzubaidy,M Scholing,SD Kuil,GJ Blaauw,W Altorf van der Kuil,SM Bierman,SC de Greeff,SR Groenendijk,R Hertroys,JCM Monen,DW Notermans,J Polman,WJ van den Reek,C Schneeberger-van der Linden,F Velthuis,CCH Wielders,BJ de Wit,RE Zoetigheid,W van den Bijllaardt,EM Kraan,MB Haeseker,JM da Silva,E de Jong,B Maraha,AJ van Griethuysen,BB Wintermans,MJCA van Trijp,AE Muller,M Wong,A Ott,E Bathoorn,M Lokate,J Sinnige,DC Melles,N Plantinga,NH Renders,JW Dorigo-Zetsma,LJ Bakker,K Waar,MT van der Beek,MA Leversteijn-van Hall,SP van Mens,E Schaftenaar,MH Nabuurs-Franssen,I Maat,PDJ Sturm,BMW Diederen,LGM Bode,DSY Ong,M van Rijn,S Dinant,M den Reijer,DW van Dam,EIGB de Brauwer,RG Bentvelsen,AGM Buiting,ALM Vlek,M de Graaf,A Troelstra,AR Jansz,MPA van Meer,J de Vries,JD Machiels

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    Citation style for this article:de Gier Brechje, van de Kassteele Jan, van Asten Liselotte, Schoffelen Annelot F, ISIS-AR study group, Hooiveld Mariette, te Wierik Margreet JM, van Sorge Nina M, de Melker Hester E.Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023.Euro Surveill. 2024;29(40):pii=2300739.https://doi.org/10.2807/1560-7917.ES.2024.29.40.2300739Received: 21 Dec 2023;Accepted: 31 Jul 2024

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Abstract

Background

After most COVID-19 pandemic control measures were lifted in 2022, many infectious diseases re-emerged. An increase in invasive group A streptococcal (iGAS) infections among adults and young children was reported by several countries. Viral infections including influenza and varicella, known risk factors for iGAS infection, also increased.

Aim

To estimate the proportion of GAS skin and soft tissue infections (SSTI) and pneumonia/sepsis in children (≤ 5 years) attributable to varicella, and the proportion of GAS pneumonia/sepsis in children and adults attributable to potentially predisposing respiratory viruses influenza A and B, RSV, hMPV and SARS-CoV-2 in the Netherlands.

Methods

We performed time series regression using weekly data on respiratory viruses, varicella and non-invasive GAS infections and GAS isolates cultured from blood, lower airways, skin, pus and wounds, from January 2010 to March 2023.

Results

In 2010–19, 50% (95% CI: 36–64) of GAS SSTI in children were attributable to varicella. Between January 2022 and March 2023, 34% (95% CI: 24–43) of GAS SSTI cases were attributable to varicella. Of iGAS pneumonia/sepsis between January 2022 and March 2023, 34% (95% CI: 20–49) and 25% (95% CI: 18–32) was attributable to respiratory virus infections in children and adults, respectively, with the largest contributor (17%) being influenza A.

Conclusions

Predisposing viral infections likely contributed to, but cannot fully explain, the observed iGAS increase among children and adults in 2022–23 in the Netherlands. Public health measures to control viral infections, such as vaccination against varicella or influenza, might reduce the iGAS disease burden.

Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (3)

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Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (4)

Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (5)

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Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023

<p class="citation"><span>Citation style for this article:</span><span class="meta-value authors"><a href="/search?value1=Brechje+de+Gier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Gier Brechje</a>, <a href="/search?value1=Jan+van+de+Kassteele&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van de Kassteele Jan</a>, <a href="/search?value1=Liselotte+van+Asten&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Asten Liselotte</a>, <a href="/search?value1=Annelot+F+Schoffelen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schoffelen Annelot F</a>, <a href="/search?value1=ISIS-AR+study+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">ISIS-AR study group</a>, <a href="/search?value1=Mariette+Hooiveld&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hooiveld Mariette</a>, <a href="/search?value1=Margreet+JM+te+Wierik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">te Wierik Margreet JM</a>, <a href="/search?value1=Nina+M+van+Sorge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Sorge Nina M</a>, <a href="/search?value1=Hester+E+de+Melker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Melker Hester E</a></span>.Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023.<a href="/content/ecdc">Euro Surveill.</a> 2024;29(40):pii=2300739.<a href="https://doi.org/10.2807/1560-7917.ES.2024.29.40.2300739" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.40.2300739</a><span class="ES_Article_citation"><span class="generated">Received</span>: 21 Dec 2023;&nbsp;&nbsp;<span class="generated">Accepted</span>: 31 Jul 2024 </span></p>

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Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023 (6)

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