Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group

To describe the incidence and clinical features of invasive group A streptococcal (GAS) disease in children in Ontario and determine the risk of invasive GAS infection following chickenpox. During 1992-1996, we conducted prospective, active, population-based surveillance for pediatric invasive GAS d...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2000-05, Vol.105 (5), p.E60
Main Authors: Laupland, K B, Davies, H D, Low, D E, Schwartz, B, Green, K, McGeer, A
Format: Article
Language:English
Subjects:
Adolescent
Age Distribution
Chickenpox - complications
Chickenpox - epidemiology
Child
Child, Preschool
Comorbidity
Female
Humans
Incidence
Infant
Infant, Newborn
Logistic Models
Male
Ontario - epidemiology
Pediatrics
Poisson Distribution
Population Surveillance
Prognosis
Prospective Studies
Risk Factors
Streptococcal Infections - complications
Streptococcal Infections - epidemiology
Streptococcal Infections - microbiology
Streptococcus pyogenes - classification
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Summary:To describe the incidence and clinical features of invasive group A streptococcal (GAS) disease in children in Ontario and determine the risk of invasive GAS infection following chickenpox. During 1992-1996, we conducted prospective, active, population-based surveillance for pediatric invasive GAS disease in Ontario, Canada (population: 11 million; 2.5 million children) and reviewed clinical and laboratory records. There were 1.9 cases of invasive GAS disease per 100,000 children per year. Streptococcal toxic shock syndrome (STSS) occurred in 7% of cases and necrotizing fasciitis (NF) in 4% for incidences of.08 and.13 per 100,000 per year, respectively. Case-fatality rates were 56% for STSS, 10% for NF, and 4% overall. The presence of chronic underlying illness other than asthma was associated with death (relative risk [RR]: 11; 95% confidence interval [CI]: 2.4-45). Fifteen percent of children identified had preceding chickenpox infection, which significantly increased the risk for acquisition of invasive GAS disease (RR: 58; 95% CI: 40-85). Children with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95% CI: 1.8-22.3). Childhood invasive GAS disease occurs at an incidence similar to the adult population but has a lower rate of STSS and case-fatality. Chickenpox dramatically increases the risk for acquiring invasive GAS disease, and universal chickenpox vaccination could potentially prevent up to 15% of all pediatric invasive GAS disease.
ISSN:0031-4005
1098-4275