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Need for vaccine to prevent streptococcal cases in children

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An effective Group A streptococcal (iGAS) vaccine is needed following a marked rise in the number of cases in children, scientists have said.

The condition can be extremely difficult to treat and is associated with a high mortality rate, according to researchers speaking at the annual meeting of the European Society of Paediatric Infectious Diseases in Dublin.

They studied data from all children with confirmed or probable iGAS infections who were admitted to Dublin tertiary hospitals during 2012-13.

“Early identification and appropriate treatment and, ultimately GAS vaccination are needed if outcomes are to improve”

Karina Butler

The team identified 56 confirmed and nine probable cases, finding there was a prevalence of 2.66 cases per 100,000 population over the study period. It was found that the number of iGAS cases rose significantly in 2012 and again in 2013, with 42% of the infected children aged two or below.

There were approximately three times more cases in girls than boys, they reported. Noting that there were seven deaths among the children identified, they reported that mortality was 11%.

Of those seven deaths, four were caused by streptococcal toxic shock syndrome (STSS), one was due to sepsis/meningitis, one was spontaneous peritonitis and one was septicaemia.

Gram-stained smear of streptococci

Gram-stained smear of streptococci

The researchers also looked at the treatment responses given to the children.

Almost half of the children (48%) needed care in the intensive care unit, 15 of whom due to severe respiratory conditions − tracheitis, empyema, pneumonia or retropharyngeal abscess.

For 70% of the children, various surgical interventions were necessary, including wound debridement, fasciotomy for compartment syndrome and insertion of chest drains to manage complicated lung abscesses.

The team looked into the risk factors for developing iGAS. For around four out of 10 children (42%) there was no identifiable risk factor, they reported, while two out of 10 (20%) developed iGAS as a complication of chickenpox.

They noted that in some children illness struck particularly aggressively, which meant there was little time for effective intervention, and that an effective Group A streptococcal vaccine was therefore needed.

Significantly, it is said that up to 20% of iGAS cases could be prevented if the existing varicella vaccine for chickenpox is used more widely.

The research was led by Dublin-based researchers – Professor Karina Butler, consultant paediatrician at Our Lady’s Children’s Hospital and University College, and Dr Juliette Lucey from the infectious diseases departments at Our Lady’s Children’s Hospital and Children’s University Hospital Dublin.

Professor Butler said: “Much of the spotlight in recent years has been on diseases such as meningitis, whooping cough and other well known infections in children. iGAS infections in children and young people are now on the rise too.

“Over 50% of children required ICU admission with the majority having no identifiable risk factor for severe disease,” she said. “Early identification and appropriate treatment and, ultimately GAS vaccination are needed if outcomes are to improve.”



J. Lucey1, M. Dominguez1, M. Meehan2, A. Redmond3, K. Butler1, R. Cunney4, P. Gavin5 1Dept Infectious Diseases, Our Lady’s Hospital for Sick Children Crumlin, Dublin, Ireland 2Epidemiology & Molecular Biology Unit, Children’s University Hospital Temple St, Dublin, Ireland 3School Of Medicine, Trinity College dublin, Dublin, Ireland 4Microbiology, Children’s University Hospital, Dublin, Ireland 5Dept Infectious Diseases, Children’s University Hospital, Dublin, Ireland


We report the resurgence of invasive group A Streptococcus (iGAS) in Ireland (2.66/100,000) with high case fatality rates (CFR) 2012, and 2013.


To determine clinical characteristics, associated morbidity, mortality and identify severity risk children during 2012-2013,


All with confirmed or probable iGAS infections admitted to Dublin tertiary paediatric centres during 2012-13 were included. Data was retrospectively collected, enhanced by national figures (Health Protection Surveillance Centre and emm typing.

Results 66 children (9 probable, 56 confirmed) with iGAS were identified, M:F ratio 1.3:1, 28 (42%) <2yrs,. Emm typing was available for 60% of cases: emm 1, 53%. CFR was 10.6%. There were 7 deaths: 4 streptococcal toxic shock syndrome (STSS), sepsis/meningitis (1), spontaneous peritonitis (1), septicaemia (1). 32 (48%) cases required ICU; including15 severe respiratory conditions (tracheitis (3), empyema (9), pneumonia (2), retropharyngeal abscess (1)). 10 (15%) had osteoarticular involvement and 2 had mastoiditis. Surgical intervention was required in 70%. Varicella associated disease occurred in 20 % (11). 4 children had other risk factors for severe disease; immunosuppressive therapy (1), CHD (1), immunodeficiency (2). 41 (62%) had no identifiable risk factor.


iGAS mortality now far exceeds that for meningococcal infection in our centre. Over 50% of children required ICU admission with the majority having no identifiable risk factor for severe disease. Early identification and appropriate treatment and, ultimately ,GAS vaccination are needed if outcomes are to improve.

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