Materiały źródłowe

• #1 Group A Streptococcal diseases: For health professionals – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/group-a-streptococcal-diseases/health-professionals.html

  Group A streptococcus (GAS) bacteria, Streptococcus pyogenes, are Gram-positive beta-hemolytic bacteria of which over 240 emm types (genotypes) have been identified. […] The Public Health Agency of Canada (PHAC) conducts annual national routine iGAS surveillance. This is done through the Canadian Notifiable Disease Surveillance System. iGAS has been nationally notifiable since January 2000. […] The National Microbiology Laboratory (NML) conducts laboratory-based surveillance of the bacteria that causes invasive GAS. Data are collected by the NML when provinces and territories send iGAS isolates for laboratory testing and emm sequencing. Laboratory data is an important source to monitor current trends in iGAS. […] Since the early 2000s, the incidence rate of iGAS has increased steadily, with the exception of 2020 and 2021, where incidence rates decreased during the COVID-19 pandemic.

• #2 Department of Health | Communicable Disease Service | Streptococcal Disease – Group A (Group A Strep)

  https://www.nj.gov/health/cd/topics/gastrep.shtml

  Group A streptococcus (GAS) bacteria are often found in the throat and on the skin. […] Severe and sometimes fatal GAS disease may occur when bacteria get into parts of the body where bacteria are not usually found such as in the blood, muscles, or lungs. […] These infections are called invasive GAS disease. […] Two of the most severe forms of invasive GAS disease are necrotizing fasciitis (also commonly known as the flesh-eating disease) and streptococcal toxic shock syndrome. […] Guidance for Managing Group A Streptococcus Cases and Outbreaks in Long-term Care Facilities UPDATED 12/15/23 […] Guidance for the Investigation and Prevention of Post-Partum Post-Surgical Invasive Group A Streptococcus Infections in Healthcare Facilities NEW! 7/31/23 […] CDC Active Bacterial Core Surveillance.

• #3 Airborne and Direct Contact Diseases – Group A Strep – Disease Surveillance Epidemiology Program – MeCDC; DHHS Maine

  https://www.maine.gov/dhhs/GAS

  Group A Streptococcus is a bacterium often found in the throat and on the skin. […] Severe, sometimes life-threatening, GAS disease may occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. […] These infections are termed „invasive GAS disease.” […] While 10%-15% of patients with invasive group A streptococcal disease die from their infection, approximately 25% of patients with necrotizing fasciitis and more than 35% with STSS die.

• #4 Pathogenesis, epidemiology and control of Group A Streptococcus infection | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-023-00865-7

  Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. […] Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants that are better adapted to the infection niche or averting host immunity. […] The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. […] The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines. […] This paper is a comprehensive epidemiological analysis of the global health burden of GAS diseases.

• #5 Strep throat epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Strep_throat_epidemiology_and_demographics

  GAS pharyngitis is the most common bacterial cause of pharyngitis. […] Worldwide, the incidence of group A stretococcal pharyngitis (GAS) is estimated to be above 616 million cases annually. […] It accounts for 20-30% cases of acute bacterial pharyngitis in children and 5-15% in adults. […] The CDC does not track the incidence of GAS pharyngitis. […] Group A streptococcal pharyngitis commonly affects children aged 5-15 years and is rare in children aged less than 3 years. […] Men and women are affected equally by Group A streptococcal pharyngitis. […] There is no racial predilection to Group A streptococcal pharyngitis. […] GAS pharyngitis is common in winter and early spring.

• #6 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  Experts estimate that several million cases of non-invasive group A strep infections occur in the United States each year. […] Group A strep infections can occur any time during the year. However, some infections are more common in the United States in certain seasons. […] Acute rheumatic fever incidence is significantly less common in the United States and developed countries compared to less developed countries. […] Worldwide, rheumatic heart disease remains a significant cause of cardiovascular disease and death.

• #7 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  While the incidence of many diseases has declined in developed countries, regions of the world with low income and poor infrastructure continue to suffer a high burden of Streptococcus pyogenes (group A streptococci) diseases with millions of deaths yearly (Carapetis, Steer, Mulholland, Weber, 2005). […] Our general understanding of the epidemiology of group A streptococci and their related diseases remains relatively poor in comparison to other infectious diseases. Many countries with established infectious disease surveillance programs undertake relatively little surveillance of diseases caused by S. pyogenes and other pyogenic streptococci. However, this has improved over the years with many countries establishing invasive group A streptococcal infection as a statutory notifiable disease.

• #8 Group A Streptococcus – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/group-a-streptococcus/

  iGAS diseases are a global cause of morbidity and mortality, but are more prevalent in populations who are living in overcrowded conditions or in socioeconomically disadvantaged regions. Globally, iGAS diseases are responsible for more than 500,000 deaths annually. […] Following the COVID-19 pandemic, several countries have witnessed an increase in iGAS. In December 2022, the World Health Organization reported an increase in iGAS cases and deaths across Europe (including France, the Netherlands, the United Kingdom, Ireland, and Sweden). Similarly, in December 2022, the U.S. Centers for Disease Control and Prevention (CDC) issued a health advisory for a spike in pediatric iGAS cases. […] iGAS is endemic in Canada, with the average number of cases rising steadily since 2000. Preliminary data from the Public Health Agency of Canada (PHAC) reported over 4,600 samples submitted to the National Microbiology Laboratory (NML) in January 2023 a record number for the country. The previous peak occurred in 2019 at roughly 3,200 cases.

• #9 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  Experts estimate that several million cases of non-invasive group A strep infections occur in the United States each year. […] Group A strep infections can occur any time during the year. However, some infections are more common in the United States in certain seasons. […] Acute rheumatic fever incidence is significantly less common in the United States and developed countries compared to less developed countries. […] Worldwide, rheumatic heart disease remains a significant cause of cardiovascular disease and death.

• #10 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  Increasing population rates in North America have been reported pre- (COVID-19) pandemic, reaching 7.6 per 100,000 population in the USA in 2019 and 10.2 in Alberta, Canada in 2017. […] The dynamic nature of S. pyogenes infection notwithstanding, contemporary data suggest an invasive S. pyogenes infections incidence of around 3 to 10 per 100,000 population in developed countries. […] Outbreaks and generalized increases in invasive S. pyogenes infection incidence among individuals experiencing homelessness, drug users, and prisoners have been periodically reported in numerous countries, and has highlighted these interrelated populations as being at particular risk. […] A distinct seasonal pattern of invasive S. pyogenes disease incidence can be noted in many temperate northern hemisphere climates.

• #11 Strep throat epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Strep_throat_epidemiology_and_demographics

  GAS pharyngitis is the most common bacterial cause of pharyngitis. […] Worldwide, the incidence of group A stretococcal pharyngitis (GAS) is estimated to be above 616 million cases annually. […] It accounts for 20-30% cases of acute bacterial pharyngitis in children and 5-15% in adults. […] The CDC does not track the incidence of GAS pharyngitis. […] Group A streptococcal pharyngitis commonly affects children aged 5-15 years and is rare in children aged less than 3 years. […] Men and women are affected equally by Group A streptococcal pharyngitis. […] There is no racial predilection to Group A streptococcal pharyngitis. […] GAS pharyngitis is common in winter and early spring.

• #12 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  Increasing population rates in North America have been reported pre- (COVID-19) pandemic, reaching 7.6 per 100,000 population in the USA in 2019 and 10.2 in Alberta, Canada in 2017. […] The dynamic nature of S. pyogenes infection notwithstanding, contemporary data suggest an invasive S. pyogenes infections incidence of around 3 to 10 per 100,000 population in developed countries. […] Outbreaks and generalized increases in invasive S. pyogenes infection incidence among individuals experiencing homelessness, drug users, and prisoners have been periodically reported in numerous countries, and has highlighted these interrelated populations as being at particular risk. […] A distinct seasonal pattern of invasive S. pyogenes disease incidence can be noted in many temperate northern hemisphere climates.

• #13 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  Experts estimate that several million cases of non-invasive group A strep infections occur in the United States each year. […] Group A strep infections can occur any time during the year. However, some infections are more common in the United States in certain seasons. […] Acute rheumatic fever incidence is significantly less common in the United States and developed countries compared to less developed countries. […] Worldwide, rheumatic heart disease remains a significant cause of cardiovascular disease and death.

• #14 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  CDC tracks invasive group A Streptococcus (group A strep) disease using 2 surveillance systems. […] Rates of serious group A strep disease have been increasing since 2014. […] Preliminary 2023 data indicate the number of serious infections caused by group A strep reached a 20-year high. […] Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. […] The U.S. rates of invasive group A strep disease began increasing in 2014. […] The increase was largest among adults aged 18 through 64 years old, but the rate also increased among older adults. […] Through ABCs, CDC tracks data on group A strep isolate resistance to certain antibiotics. […] Around 1 in 3 invasive group A strep infections are now caused by bacteria that are resistant to erythromycin and clindamycin.

• #15 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  CDC tracks invasive group A Streptococcus (group A strep) disease using 2 surveillance systems. […] Rates of serious group A strep disease have been increasing since 2014. […] Preliminary 2023 data indicate the number of serious infections caused by group A strep reached a 20-year high. […] Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. […] The U.S. rates of invasive group A strep disease began increasing in 2014. […] The increase was largest among adults aged 18 through 64 years old, but the rate also increased among older adults. […] Through ABCs, CDC tracks data on group A strep isolate resistance to certain antibiotics. […] Around 1 in 3 invasive group A strep infections are now caused by bacteria that are resistant to erythromycin and clindamycin.

• #16 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  A surveillance study of 10 US states shows the incidence of invasive group A Streptococcus (GAS) infection more than doubled from 2013 through 2022, researchers reported yesterday in JAMA. […] The authors of the study say that while that trend has continued, the substantial increase they found over the following decade reflects elevated incidence and outbreaks among groups that have been socially and economically marginalized. […] From 2013 through 2022, surveillance in the 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) identified 21,312 cases of invasive GAS, with 20,247 hospitalizations and 1,981 deaths. […] Incidence of invasive GAS rose from 3.6 per 100,000 in 2013 to 8.2 per 100,000 in 2022. […] The increase in invasive GAS incidence came despite significant decreases during the COVID-19 pandemic, when incidence fell by 73% among children younger than 18 and by 33% among adults 65 and older.

• #17 Invasive group A streptococcal disease surveillance in Canada, 2020, CCDR 48(9) – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-9-september-2022/invasive-group-a-streptococcal-disease-surveillance-canada-2020.html

  Invasive group A streptococcal (iGAS) disease (caused by Streptococcus pyogenes) has been a nationally notifiable disease in Canada since 2000. This report summarizes the demographics, emm types and antimicrobial resistance of iGAS infections in Canada in 2020. […] The Public Health Agency of Canada’s National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of invasive S. pyogenes. […] Overall, the incidence of iGAS disease in Canada has increased from 4.0 to 8.1 cases per 100,000 population from 2009 to 2019. […] Though the number of collected invasive S. pyogenes isolates decreased slightly in 2020 in comparison to previous years, iGAS disease remains an important public health concern.

• #18 Group A Streptococcus – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/group-a-streptococcus/

  iGAS diseases are a global cause of morbidity and mortality, but are more prevalent in populations who are living in overcrowded conditions or in socioeconomically disadvantaged regions. Globally, iGAS diseases are responsible for more than 500,000 deaths annually. […] Following the COVID-19 pandemic, several countries have witnessed an increase in iGAS. In December 2022, the World Health Organization reported an increase in iGAS cases and deaths across Europe (including France, the Netherlands, the United Kingdom, Ireland, and Sweden). Similarly, in December 2022, the U.S. Centers for Disease Control and Prevention (CDC) issued a health advisory for a spike in pediatric iGAS cases. […] iGAS is endemic in Canada, with the average number of cases rising steadily since 2000. Preliminary data from the Public Health Agency of Canada (PHAC) reported over 4,600 samples submitted to the National Microbiology Laboratory (NML) in January 2023 a record number for the country. The previous peak occurred in 2019 at roughly 3,200 cases.

• #19 Increase in Invasive Group A streptococcal infections among children in Europe, including fatalities 

  https://www.ecdc.europa.eu/en/news-events/increase-invasive-group-streptococcal-infections-among-children-europe-including

  A number of European countries (including Ireland, France, the Netherlands, Sweden and the United Kingdom) indicate an increase seen during 2022, particularly since September 2022, in the number of cases of invasive Group A Streptococcus (iGAS) disease among children less than ten years of age. […] During the same period, several deaths associated with iGAS in children less than 10 years of age have also been reported, including from Ireland, France, and the UK. […] The observed increases reported to the European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe and have followed a period of reduced incidence of Group A Streptococcus infections observed during the COVID-19 pandemic. […] GAS and iGAS infections are notifiable diseases in only a limited number of European countries, therefore it is difficult to assess the overall level of circulation in the European region at this point.

• #20 Group A Streptococcus – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/group-a-streptococcus/

  iGAS diseases are a global cause of morbidity and mortality, but are more prevalent in populations who are living in overcrowded conditions or in socioeconomically disadvantaged regions. Globally, iGAS diseases are responsible for more than 500,000 deaths annually. […] Following the COVID-19 pandemic, several countries have witnessed an increase in iGAS. In December 2022, the World Health Organization reported an increase in iGAS cases and deaths across Europe (including France, the Netherlands, the United Kingdom, Ireland, and Sweden). Similarly, in December 2022, the U.S. Centers for Disease Control and Prevention (CDC) issued a health advisory for a spike in pediatric iGAS cases. […] iGAS is endemic in Canada, with the average number of cases rising steadily since 2000. Preliminary data from the Public Health Agency of Canada (PHAC) reported over 4,600 samples submitted to the National Microbiology Laboratory (NML) in January 2023 a record number for the country. The previous peak occurred in 2019 at roughly 3,200 cases.

• #21 Invasive Group A Streptococcal Disease: a Resurging Menace?

  https://www.cepheid.com/en-US/insights/insight-hub/tech-disease-trends/2024/11/invasive-group-streptococcal-disease.html

  Epidemiological data indicated a significant increase in iGAS cases across Europe, including France, Ireland, the Netherlands, Sweden, and the United Kingdom in 2022. Children under 10 years of age were the group most affected in these outbreaks. […] Australia experienced a similar post-pandemic increase and Canada saw over 4,600 cases of iGAS in 2023, a 40% increase over the previous yearly high. […] The U.S. Centers for Disease Control and Prevention (CDC) reported that rates of serious GAS disease have been increasing since 2014, but the number of serious GAS infections reached a 20-year high in 2023. According to the CDC, there have been between 20,000 to 27,000 cases of iGAS per year in the U.S. in the last 5 years, resulting in approximately 2,000 deaths each year. […] An ongoing outbreak in Japan has recorded 977 cases of STSS in the first half of 2024, surpassing 2023s previous record of 941 preliminary infections. A record 77 deaths were reported in the first three months of 2024 due to iGAS STSS, approaching the 97 deaths caused by STSS last year which was the second-highest number of fatalities since 2019.

• #22 Invasive Group A Streptococcal Disease: a Resurging Menace?

  https://www.cepheid.com/en-US/insights/insight-hub/tech-disease-trends/2024/11/invasive-group-streptococcal-disease.html

  Epidemiological data indicated a significant increase in iGAS cases across Europe, including France, Ireland, the Netherlands, Sweden, and the United Kingdom in 2022. Children under 10 years of age were the group most affected in these outbreaks. […] Australia experienced a similar post-pandemic increase and Canada saw over 4,600 cases of iGAS in 2023, a 40% increase over the previous yearly high. […] The U.S. Centers for Disease Control and Prevention (CDC) reported that rates of serious GAS disease have been increasing since 2014, but the number of serious GAS infections reached a 20-year high in 2023. According to the CDC, there have been between 20,000 to 27,000 cases of iGAS per year in the U.S. in the last 5 years, resulting in approximately 2,000 deaths each year. […] An ongoing outbreak in Japan has recorded 977 cases of STSS in the first half of 2024, surpassing 2023s previous record of 941 preliminary infections. A record 77 deaths were reported in the first three months of 2024 due to iGAS STSS, approaching the 97 deaths caused by STSS last year which was the second-highest number of fatalities since 2019.

• #23 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  Numerous epidemiological studies have identified high rates of invasive S. pyogenes infection in men rather than women, a pattern that can be observed for many other invasive bacterial infections and one that is not fully understood. […] Assessment of rates of disease according to patient ethnicity show generally higher rates of disease in individuals of non-white European descent. […] The reasons behind these excesses in risk are poorly understood and could reflect differential access to healthcare, living conditions or prevalence of comorbidities but could also encompass some genetic predisposing factors. […] While numerous observational studies have described the frequencies of potential risk or predisposing factors in patients with invasive S. pyogenes disease, rigorous assessment through analytical means has been rather more limited.

• #24 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  Numerous epidemiological studies have identified high rates of invasive S. pyogenes infection in men rather than women, a pattern that can be observed for many other invasive bacterial infections and one that is not fully understood. […] Assessment of rates of disease according to patient ethnicity show generally higher rates of disease in individuals of non-white European descent. […] The reasons behind these excesses in risk are poorly understood and could reflect differential access to healthcare, living conditions or prevalence of comorbidities but could also encompass some genetic predisposing factors. […] While numerous observational studies have described the frequencies of potential risk or predisposing factors in patients with invasive S. pyogenes disease, rigorous assessment through analytical means has been rather more limited.

• #25 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  A key epidemiological feature of invasive S. pyogenes disease is its occurrence in individuals with no identified risk factors or predisposing conditions, which occurs in around 20-30% of all invasive S. pyogenes cases. […] The introduction of novel strains within a population has long been demonstrated as a cause of upsurge in S. pyogenes disease incidence, with the advancement of whole genome sequencing providing evidence for this phenomenon. […] The role of the environment in facilitating the spread of S. pyogenes is potentially under-recognized, despite well-documented accounts supporting its role in facilitating disease transmission. […] The molecular surveillance of S. pyogenes recovered from human infections worldwide is therefore crucial for providing information on possible shifts in clone prevalence with an impact on vaccine development, as well as for the early detection of clones with enhanced virulence, transmission, or antimicrobial resistance.

• #26 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  The percentage of adult patients with one or more underlying condition rose increased from 86.6% in 2013 to 93% in 2022. […] „An increasing prevalence of underlying health conditions associated with invasive GAS likely contributed to rising incidence,” the study authors wrote. […] The analysis also found rising levels of antibiotic resistance among invasive GAS isolates. […] In the accompanying editorial, Osowicki and Theresa Lamagni, MSc, PhD, of the United Kingdom Health Security Agency note that increases in invasive GAS have also been reported in other high-income countries, particularly in the immediate wake of COVID-19. […] They also suggest that the increase in incidence might even be greater, since the ABC surveillance system doesn’t include 8 of the 10 poorest US states. […] „Overall, the theme of this US invasive GAS disease update looks to be a backward slide in the social determinants of invasive GAS, most evident in, but not limited to, disadvantaged and marginalized populations in the US,” Osowicki and Lamagni wrote. […] Whatever is driving the increase in invasive GAS incidence, the study authors say it requires urgent attention.

• #27 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  Increasing population rates in North America have been reported pre- (COVID-19) pandemic, reaching 7.6 per 100,000 population in the USA in 2019 and 10.2 in Alberta, Canada in 2017. […] The dynamic nature of S. pyogenes infection notwithstanding, contemporary data suggest an invasive S. pyogenes infections incidence of around 3 to 10 per 100,000 population in developed countries. […] Outbreaks and generalized increases in invasive S. pyogenes infection incidence among individuals experiencing homelessness, drug users, and prisoners have been periodically reported in numerous countries, and has highlighted these interrelated populations as being at particular risk. […] A distinct seasonal pattern of invasive S. pyogenes disease incidence can be noted in many temperate northern hemisphere climates.

• #28 Group A Streptococcus – National Collaborating Centre for Infectious Diseases

  https://nccid.ca/debrief/group-a-streptococcus/

  The average number of iGAS cases has risen in the United States in the past two decades. Several million cases of noninvasive GAS and between 14,000 to 25,000 cases of iGAS occur in the U.S. each year. iGAS has also contributed to between 1,500 to 2,300 deaths annually in the U.S. in the past five years. […] Since 2022, increases in iGAS cases and deaths have been reported in several provinces across Canada. For example, the iGAS-related mortality in New Brunswick increased from 6 deaths annually (2018-2022) to 10 deaths in 2023. Within the first two weeks of January 2024, 2 deaths have already occurred including in a child under the age of 9. In Ontario, the number of iGAS cases between October 1, 2022 to September 30, 2023 was higher compared to previous pre-pandemic seasons. […] Because GAS is commonly transmitted person-to-person by coughing or sneezing, transmission rates are higher in overcrowded and/or enclosed social settings, such as schools, nurseries, hospitals, homeless shelters, and residential care homes. […] Risk factors for GAS infection have also been associated with underlying, chronic medical conditions including diabetes, lung disease, liver disease, and heart disease.

• #29 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  While the incidence of many diseases has declined in developed countries, regions of the world with low income and poor infrastructure continue to suffer a high burden of Streptococcus pyogenes (group A streptococci) diseases with millions of deaths yearly (Carapetis, Steer, Mulholland, Weber, 2005). […] Our general understanding of the epidemiology of group A streptococci and their related diseases remains relatively poor in comparison to other infectious diseases. Many countries with established infectious disease surveillance programs undertake relatively little surveillance of diseases caused by S. pyogenes and other pyogenic streptococci. However, this has improved over the years with many countries establishing invasive group A streptococcal infection as a statutory notifiable disease.

• #30 Group A Strep Infection | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/index.html

  CDC uses two systems to track invasive group A strep infections in the United States. […] Public health officials investigate group A Streptococcus outbreaks and identify control measures.

• #31 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  CDC tracks invasive group A Streptococcus (group A strep) disease using 2 surveillance systems. […] Rates of serious group A strep disease have been increasing since 2014. […] Preliminary 2023 data indicate the number of serious infections caused by group A strep reached a 20-year high. […] Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. […] The U.S. rates of invasive group A strep disease began increasing in 2014. […] The increase was largest among adults aged 18 through 64 years old, but the rate also increased among older adults. […] Through ABCs, CDC tracks data on group A strep isolate resistance to certain antibiotics. […] Around 1 in 3 invasive group A strep infections are now caused by bacteria that are resistant to erythromycin and clindamycin.

• #32 Group A Strep | Surveillance | GAS | CDC

  http://medbox.iiab.me/modules/en-cdc/www.cdc.gov/groupastrep/surveillance.html

  CDC tracks invasive group A strep infections through Active Bacterial Core surveillance (ABCs), a population-based, active- and laboratory-based surveillance system. This means local and state health departments routinely contact laboratories to identify all cases, then report those cases to CDC. […] Only streptococcal toxic shock syndrome is currently a nationally reported disease. Healthcare providers and laboratories should report cases to the appropriate health department. States then report these cases to CDC through the National Notifiable Diseases Surveillance System (NNDSS).

• #33 Group A Strep Infection | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/index.html

  CDC uses two systems to track invasive group A strep infections in the United States. […] Public health officials investigate group A Streptococcus outbreaks and identify control measures.

• #34 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  The size and severity of the burden of S. pyogenes disease highlights the importance of epidemiologic surveillance to detect changes in disease distribution in various populations. […] Modern-day surveillance programs tend to focus on invasive S. pyogenes disease, with legislation in place in many countries that requires statutory notification, in recognition of the importance of rapid public health action following the diagnosis of a single case. […] Laboratory-based surveillance systems are commonly adopted as a means to monitor invasive S. pyogenes infections. […] Surveillance systems and methods for common non-invasive S. pyogenes manifestations are more variable and sparse between countries. […] With the establishment of surveillance systems for invasive S. pyogenes infections in many developed countries, data are being accumulated to allow researchers to assess longitudinal patterns in disease incidence.

• #35 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  The size and severity of the burden of S. pyogenes disease highlights the importance of epidemiologic surveillance to detect changes in disease distribution in various populations. […] Modern-day surveillance programs tend to focus on invasive S. pyogenes disease, with legislation in place in many countries that requires statutory notification, in recognition of the importance of rapid public health action following the diagnosis of a single case. […] Laboratory-based surveillance systems are commonly adopted as a means to monitor invasive S. pyogenes infections. […] Surveillance systems and methods for common non-invasive S. pyogenes manifestations are more variable and sparse between countries. […] With the establishment of surveillance systems for invasive S. pyogenes infections in many developed countries, data are being accumulated to allow researchers to assess longitudinal patterns in disease incidence.

• #36 Invasive group A streptococcal disease surveillance in Canada, 2020, CCDR 48(9) – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-9-september-2022/invasive-group-a-streptococcal-disease-surveillance-canada-2020.html

  It is important to continue surveillance of S. pyogenes in Canada to monitor expanding replacement emm types, as well as outbreak clones and antimicrobial resistance. […] Surveillance of iGAS infections in Canada consists of a passive, laboratory-based system where invasive S. pyogenes isolates from all provincial and territorial public health laboratories (except Alberta) are sent to the National Microbiology Laboratory (NML) in Winnipeg for further testing. […] Population-based incidence of iGAS disease up to 2019 was obtained through Canadian Notifiable Disease Surveillance System (CNDSS). […] The overall incidence of iGAS disease in Canada decreased slightly in 2019 after successive annual increases from 2009 to 2018. […] The most predominant emm types overall in 2020 were emm49 (16.8%, n=483) and emm76 (15.0%, n=429), which have increased significantly in prevalence since 2016.

• #37 Group A streptococcal disease – invasive (iGAS) | Australian Government Department of Health and Aged Care

  https://www.health.gov.au/diseases/group-a-streptococcal-disease-invasive-igas

  Group A streptococcus (GAS), is a type of bacteria often found in the throat and on the skin. Group A streptococcal infections commonly cause sore throats, also known as strep throat. In rare cases the bacteria can also cause a severe, life-threatening infection known as invasive group A streptococcal disease (iGAS). […] iGAS is a nationally notifiable disease. […] We monitor cases through the National Notifiable Diseases Surveillance System.

• #38 Increase in Invasive Group A streptococcal infections among children in Europe, including fatalities 

  https://www.ecdc.europa.eu/en/news-events/increase-invasive-group-streptococcal-infections-among-children-europe-including

  A number of European countries (including Ireland, France, the Netherlands, Sweden and the United Kingdom) indicate an increase seen during 2022, particularly since September 2022, in the number of cases of invasive Group A Streptococcus (iGAS) disease among children less than ten years of age. […] During the same period, several deaths associated with iGAS in children less than 10 years of age have also been reported, including from Ireland, France, and the UK. […] The observed increases reported to the European Centre for Disease Prevention and Control (ECDC) and WHO Regional Office for Europe and have followed a period of reduced incidence of Group A Streptococcus infections observed during the COVID-19 pandemic. […] GAS and iGAS infections are notifiable diseases in only a limited number of European countries, therefore it is difficult to assess the overall level of circulation in the European region at this point.

• #39

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. […] An effective surveillance system for invasive Strep A serves to monitor trends in the following (1) numbers or incidence rates of laboratory-confirmed invasive Strep A infection for a defined population; (2) demographic and clinical characteristics of patients; (3) age- and sex-specific incidence of invasive infections; and (4) incidence rates of death and nonfatal sequelae due to invasive Strep A infections.

• #40

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. […] An effective surveillance system for invasive Strep A serves to monitor trends in the following (1) numbers or incidence rates of laboratory-confirmed invasive Strep A infection for a defined population; (2) demographic and clinical characteristics of patients; (3) age- and sex-specific incidence of invasive infections; and (4) incidence rates of death and nonfatal sequelae due to invasive Strep A infections.

• #41

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. […] An effective surveillance system for invasive Strep A serves to monitor trends in the following (1) numbers or incidence rates of laboratory-confirmed invasive Strep A infection for a defined population; (2) demographic and clinical characteristics of patients; (3) age- and sex-specific incidence of invasive infections; and (4) incidence rates of death and nonfatal sequelae due to invasive Strep A infections.

• #42

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Invasive group A streptococcal (Strep A) infections occur when Streptococcus pyogenes, also known as beta-hemolytic group A Streptococcus, invades a normally sterile site in the body. This article provides guidelines for establishing surveillance for invasive Strep A infections. The primary objective of invasive Strep A surveillance is to monitor trends in rates of infection and determine the demographic and clinical characteristics of patients with laboratory-confirmed invasive Strep A infection, the age- and sex-specific incidence in the population of a defined geographic area, trends in risk factors, and the mortality rates and rates of nonfatal sequelae caused by invasive Strep A infections. […] An effective surveillance system for invasive Strep A serves to monitor trends in the following (1) numbers or incidence rates of laboratory-confirmed invasive Strep A infection for a defined population; (2) demographic and clinical characteristics of patients; (3) age- and sex-specific incidence of invasive infections; and (4) incidence rates of death and nonfatal sequelae due to invasive Strep A infections.

• #43

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  The minimum surveillance for invasive Strep A infection is facility-based, passive surveillance. […] Enhanced surveillance results in a more precise estimation of age-specific disease and fatality rates than other surveillance methods. Enhanced surveillance for invasive Strep A infection is prospective, active, facility-based surveillance.

• #44

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Enhanced surveillance systems may also aim to determine and monitor the distribution of select genotypic or phenotypic features (ie, emm types, virulence factors, presence of vaccine antigens, and antimicrobial susceptibility) of Strep A strains to (1) measure strain-specific disease burden and facilitate outbreak detection; (2) monitor trends in Strep A strains causing invasive disease to detect shifts in predominant or virulent strains over time, including shifts due to strain-specific vaccination; (3) track antimicrobial resistance over time; and (4) predict and evaluate the effectiveness of future or existing strain-specific vaccines. […] Standardized case definitions are important for obtaining accurate surveillance data, comparing burden estimates and case fatality rates across surveillance sites, and monitoring the impact of vaccines and other interventions. The case definitions for invasive Strep A infections in Table 1 have been adapted from the US Centers for Disease Control and Prevention (CDC)s Active Bacterial Core surveillance (which established uniform criteria for reporting cases of invasive Strep A infections) and the Working Group on Severe Streptococcal Infections, which established a case definition for STSS.

• #45

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Enhanced surveillance systems may also aim to determine and monitor the distribution of select genotypic or phenotypic features (ie, emm types, virulence factors, presence of vaccine antigens, and antimicrobial susceptibility) of Strep A strains to (1) measure strain-specific disease burden and facilitate outbreak detection; (2) monitor trends in Strep A strains causing invasive disease to detect shifts in predominant or virulent strains over time, including shifts due to strain-specific vaccination; (3) track antimicrobial resistance over time; and (4) predict and evaluate the effectiveness of future or existing strain-specific vaccines. […] Standardized case definitions are important for obtaining accurate surveillance data, comparing burden estimates and case fatality rates across surveillance sites, and monitoring the impact of vaccines and other interventions. The case definitions for invasive Strep A infections in Table 1 have been adapted from the US Centers for Disease Control and Prevention (CDC)s Active Bacterial Core surveillance (which established uniform criteria for reporting cases of invasive Strep A infections) and the Working Group on Severe Streptococcal Infections, which established a case definition for STSS.

• #46

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9474937/

  Enhanced surveillance systems may also aim to determine and monitor the distribution of select genotypic or phenotypic features (ie, emm types, virulence factors, presence of vaccine antigens, and antimicrobial susceptibility) of Strep A strains to (1) measure strain-specific disease burden and facilitate outbreak detection; (2) monitor trends in Strep A strains causing invasive disease to detect shifts in predominant or virulent strains over time, including shifts due to strain-specific vaccination; (3) track antimicrobial resistance over time; and (4) predict and evaluate the effectiveness of future or existing strain-specific vaccines. […] Standardized case definitions are important for obtaining accurate surveillance data, comparing burden estimates and case fatality rates across surveillance sites, and monitoring the impact of vaccines and other interventions. The case definitions for invasive Strep A infections in Table 1 have been adapted from the US Centers for Disease Control and Prevention (CDC)s Active Bacterial Core surveillance (which established uniform criteria for reporting cases of invasive Strep A infections) and the Working Group on Severe Streptococcal Infections, which established a case definition for STSS.

• #47 Group A Strep Disease Surveillance and Trends | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/php/surveillance/index.html

  CDC tracks invasive group A Streptococcus (group A strep) disease using 2 surveillance systems. […] Rates of serious group A strep disease have been increasing since 2014. […] Preliminary 2023 data indicate the number of serious infections caused by group A strep reached a 20-year high. […] Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. […] The U.S. rates of invasive group A strep disease began increasing in 2014. […] The increase was largest among adults aged 18 through 64 years old, but the rate also increased among older adults. […] Through ABCs, CDC tracks data on group A strep isolate resistance to certain antibiotics. […] Around 1 in 3 invasive group A strep infections are now caused by bacteria that are resistant to erythromycin and clindamycin.

• #48 Invasive group A streptococcal disease surveillance in Canada, 2020, CCDR 48(9) – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-9-september-2022/invasive-group-a-streptococcal-disease-surveillance-canada-2020.html

  The most prevalent emm type collected in Canada over the past decade was emm1, accounting for over 25% of reported iGAS cases in the early 2010s and reflecting levels reported in Europe and North America. […] Despite decreasing in prevalence for a number of years, emm1 has only been surpassed by emm76 in 2019, and by emm49 in 2020. […] In 2020, common emm types in Canada that had high levels (more than 40%) of erythromycin and clindamycin resistance included emm11, emm77, emm83 and emm92. […] Continued surveillance of invasive S. pyogenes in Canada is imperative to monitor these expanding replacement emm types, as well as outbreak clones and antimicrobial resistance.

• #49 Invasive group A streptococcal disease surveillance in Canada, 2020, CCDR 48(9) – Canada.ca

  https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2022-48/issue-9-september-2022/invasive-group-a-streptococcal-disease-surveillance-canada-2020.html

  The most prevalent emm type collected in Canada over the past decade was emm1, accounting for over 25% of reported iGAS cases in the early 2010s and reflecting levels reported in Europe and North America. […] Despite decreasing in prevalence for a number of years, emm1 has only been surpassed by emm76 in 2019, and by emm49 in 2020. […] In 2020, common emm types in Canada that had high levels (more than 40%) of erythromycin and clindamycin resistance included emm11, emm77, emm83 and emm92. […] Continued surveillance of invasive S. pyogenes in Canada is imperative to monitor these expanding replacement emm types, as well as outbreak clones and antimicrobial resistance.

• #50 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  The percentage of adult patients with one or more underlying condition rose increased from 86.6% in 2013 to 93% in 2022. […] „An increasing prevalence of underlying health conditions associated with invasive GAS likely contributed to rising incidence,” the study authors wrote. […] The analysis also found rising levels of antibiotic resistance among invasive GAS isolates. […] In the accompanying editorial, Osowicki and Theresa Lamagni, MSc, PhD, of the United Kingdom Health Security Agency note that increases in invasive GAS have also been reported in other high-income countries, particularly in the immediate wake of COVID-19. […] They also suggest that the increase in incidence might even be greater, since the ABC surveillance system doesn’t include 8 of the 10 poorest US states. […] „Overall, the theme of this US invasive GAS disease update looks to be a backward slide in the social determinants of invasive GAS, most evident in, but not limited to, disadvantaged and marginalized populations in the US,” Osowicki and Lamagni wrote. […] Whatever is driving the increase in invasive GAS incidence, the study authors say it requires urgent attention.

• #51 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  The highly invasive nature of GAS is attributed to many factors. M protein, a surface antigen of leading virulence, is encoded by the emm gene and has a crucial role in the pathogenesis of invasion and phagocytosis. Emm sequence typing, mainly via the 5′ end of the M protein (emm) gene, is widely used in several epidemiological studies in Europe and the USA to observe changes in the geographical and temporal alteration of GAS infection, to assess invasive or non-invasive GAS infection rates, and to correlate emm typing with the occurrence of invasive disease. […] The majority of studies agree that iGAS cases coincided with or followed viral infection, especially RSV, Influenza A/B, Varicella zoster, and human metapneumovirus. In 2022 and 2023, a surge in viral outbreaks was noted, especially concerning RSV and Influenza A/B, designating no seasonal pattern, with Influenza B continuing until the late spring of 2023.

• #52

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  As of 8 December 2022, at least five Member States in the European Region reported to WHO an increase in cases of invasive group A streptococcus (iGAS) disease and in some cases also scarlet fever. […] The observed increase may reflect an early start to the GAS infection season coinciding with an increase in the circulation of respiratory viruses and possible viral coinfection which may increase the risk of invasive GAS disease. […] During 2022, France, Ireland, the Netherlands, Sweden, and the United Kingdom of Great Britain and Northern Ireland, have been observing an increase in cases of invasive group A streptococcus disease and scarlet fever, mostly affecting children under 10 years of age. […] The Public Health Agency of the Netherlands (RIVM) observed an increase in iGAS infections among children from March 2022 onward.

• #53 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  Group A streptococcus (GAS) is the cause of both mild and invasive infections in humans with a high morbidity and mortality rate. The transmission of disease usually occurs via droplets, so the implementation of infection mitigation strategies (IMS) during the COVID-19 pandemic altered the incidence of GAS infection. This review aims to provide an overview of the influence of the COVID-19 pandemic on the incidence of GAS infection in children (invasive or non-invasive). A surge in the incidence of invasive GAS infection was noted in December 2022 after the reversal of IMS. A global uprise in GAS infection (invasive and non-invasive) was noted, especially concerning the pediatric population. Children younger than 5 years old were mostly affected, with complicated pneumonia being the leading clinical manifestation, causing many deaths worldwide. Emm1, specifically M1UK, was recognized as the dominant lineage in Europe and correlated with invasive disease. Healthcare professionals need to be alert about the severity of GAS-related infections, leading to early identification and treatment.

• #54 CDC study finds substantial US increase in invasive group A strep infections | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/cdc-study-finds-substantial-us-increase-invasive-group-strep-infections

  A surveillance study of 10 US states shows the incidence of invasive group A Streptococcus (GAS) infection more than doubled from 2013 through 2022, researchers reported yesterday in JAMA. […] The authors of the study say that while that trend has continued, the substantial increase they found over the following decade reflects elevated incidence and outbreaks among groups that have been socially and economically marginalized. […] From 2013 through 2022, surveillance in the 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee) identified 21,312 cases of invasive GAS, with 20,247 hospitalizations and 1,981 deaths. […] Incidence of invasive GAS rose from 3.6 per 100,000 in 2013 to 8.2 per 100,000 in 2022. […] The increase in invasive GAS incidence came despite significant decreases during the COVID-19 pandemic, when incidence fell by 73% among children younger than 18 and by 33% among adults 65 and older.

• #55 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  The purpose of this review is to provide an overview of the influence of the COVID-19 pandemic on the incidence of GAS infection in children (invasive or non-invasive). […] Epidemiological data from Germany, as reported by Goretzki et al., noted an outbreak of iGAS infection in the last trimester of 2022 in the pediatric population, with a median age of 4 years old, mainly presented as pneumonia, followed by STSS, with a high viral co-infection rate of 46% and a high ICU admission rate of 59% and death rate, when compared to statistics of pre-pandemic years. […] A similar observation is noted by Tomidis Chatzimanouil et al. in a retrospective cohort study also conducted in Germany. They detected a rise of the iGAS infection rate in the pediatric population by 1200% in the first half of 2023 when compared to older data and a high occurrence of sepsis, STSS, and complicated pneumonia.

• #56 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  The purpose of this review is to provide an overview of the influence of the COVID-19 pandemic on the incidence of GAS infection in children (invasive or non-invasive). […] Epidemiological data from Germany, as reported by Goretzki et al., noted an outbreak of iGAS infection in the last trimester of 2022 in the pediatric population, with a median age of 4 years old, mainly presented as pneumonia, followed by STSS, with a high viral co-infection rate of 46% and a high ICU admission rate of 59% and death rate, when compared to statistics of pre-pandemic years. […] A similar observation is noted by Tomidis Chatzimanouil et al. in a retrospective cohort study also conducted in Germany. They detected a rise of the iGAS infection rate in the pediatric population by 1200% in the first half of 2023 when compared to older data and a high occurrence of sepsis, STSS, and complicated pneumonia.

• #57 Group A Streptococcus Infections in Children: Epidemiological Insights Before and After the COVID-19 Pandemic

  https://www.mdpi.com/2076-0817/13/11/1007

  Epidemiological data reflecting the influence of the COVID-19 pandemic on GAS infection are reported in many countries around the world. Details on the incidence of GAS infection before and after the COVID-19 pandemic are depicted in Table 1. […] The COVID-19 pandemic led to a decrease in GAS-related bloodstream infections, as reported by Amarsy et al. in Paris, France, in 2020. In a prospective study, Cohen et al. additionally noted a decrease in non-invasive GAS infection in France in 2020, followed by a rise in the cases after March 2022 with an increase in a rate of +23.8% per month, as monitored via rapid antigen strep tests, mainly manifesting as tonsillopharyngitis. […] At the end of the COVID-19 pandemic, when IMS were reversed, a rise in GAS infection was noted. On 12 December 2022, the World Health Organization (WHO) stated an increase in iGAS infection in several European countries, especially in the United Kingdom, France, Spain, Sweden, and Denmark, with the United Kingdom reporting a high rate of iGAS infection in children accompanied by several deaths in a brief timeframe. A similar trend was noted by the Centers for Disease Control and Prevention (CDC) in February 2023 regarding iGAS infection in the USA.

• #58

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  According to the UK Health Security Agency, following a higher-than-expected scarlet fever activity in the summer in England, with a decrease during August 2022, notifications from mid-September to early December have increased again, remaining above what is normally seen at this time of year. […] Enhanced surveillance activities have been implemented in the countries reporting an increase in iGAS cases, together with public health messages addressing the general population and clinicians, in order to enhance early recognition, reporting and prompt treatment initiation of GAS cases. […] WHO currently assesses the risk for the general population posed by the reported increase in iGAS infections in some European countries as low, considering the moderate rise in iGAS cases, GAS endemicity, no newly emerging emm gene sequence types identified, and no observed increases in antibiotic resistance.

• #59 Surveillance study spots long-term rise in invasive group A strep infections among children

  https://medicalxpress.com/news/2025-04-surveillance-term-invasive-group-strep.html

  A 32-year-long surveillance study led by Sinai Health in Toronto has found that serious infections caused by group A streptococcus (iGAS) are rising in children, with the sharpest increase recorded in 2023. […] In the study, „Invasive Group A Streptococcal Infection in Children, 1992–2023,” published in JAMA Network Open, researchers conducted a case series to describe the epidemiology of pediatric iGAS over time. […] All reported pediatric cases of iGAS were identified through population-based surveillance in Toronto and Peel Region, Ontario, from 1992 through 2023. The surveillance area covered a population of 4.5 million, with data collected through medical record reviews of 28 hospitals and 25 clinical laboratories serving the region. […] Annual incidence increased from 1.8 cases per 100,000 population during 1992 to 2011, to 2.4 in 2012 to 2019.

• #60 Surveillance study spots long-term rise in invasive group A strep infections among children

  https://medicalxpress.com/news/2025-04-surveillance-term-invasive-group-strep.html

  By 2023, incidence surged to 6.0 per 100,000, the highest rate observed in the 32-year study period. […] Researchers concluded that the surge in pediatric iGAS infections observed after the COVID-19 pandemic may reflect increased susceptibility among children due to reduced exposure to common pathogens during lockdowns. […] While overall disease characteristics remained stable over time, the proportion of infections involving the respiratory tract increased.

• #61 Surveillance study spots long-term rise in invasive group A strep infections among children

  https://medicalxpress.com/news/2025-04-surveillance-term-invasive-group-strep.html

  By 2023, incidence surged to 6.0 per 100,000, the highest rate observed in the 32-year study period. […] Researchers concluded that the surge in pediatric iGAS infections observed after the COVID-19 pandemic may reflect increased susceptibility among children due to reduced exposure to common pathogens during lockdowns. […] While overall disease characteristics remained stable over time, the proportion of infections involving the respiratory tract increased.

• #62 Physicians should be on alert for group A strep as cases experience historic rise, study finds – UTHealth Houston

  https://www.uth.edu/news/story/physicians-should-be-on-alert-for-group-a-strep-as-cases-experience-historic-rise-study-finds

  The U.S. experienced an unprecedented number of group A streptococcal infections in children from October to December of 2022, which should alert physicians to check for the potentially deadly infectious disease as the country moves out of the pandemic, according to research published by UTHealth Houston. […] In 2022, a total of 318 individual group A strep cases were identified in young children in Houston. […] As cases of group A strep continued to be high in the first quarter of 2023 in Houston, the disease is a cause for concern for pediatricians who see children with symptoms of group A strep. […] The reason why this is important is we’re seeing group A strep more frequently than what we have seen in the past, and therefore, if a physician has a child coming in with a sore throat or with a skin infection, we should have a high index of suspicion for group A strep, Flores said.

• #63

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  According to the UK Health Security Agency, following a higher-than-expected scarlet fever activity in the summer in England, with a decrease during August 2022, notifications from mid-September to early December have increased again, remaining above what is normally seen at this time of year. […] Enhanced surveillance activities have been implemented in the countries reporting an increase in iGAS cases, together with public health messages addressing the general population and clinicians, in order to enhance early recognition, reporting and prompt treatment initiation of GAS cases. […] WHO currently assesses the risk for the general population posed by the reported increase in iGAS infections in some European countries as low, considering the moderate rise in iGAS cases, GAS endemicity, no newly emerging emm gene sequence types identified, and no observed increases in antibiotic resistance.

• #64 Pathogenesis, epidemiology and control of Group A Streptococcus infection | Nature Reviews Microbiology

  https://www.nature.com/articles/s41579-023-00865-7

  Streptococcus pyogenes (Group A Streptococcus; GAS) is exquisitely adapted to the human host, resulting in asymptomatic infection, pharyngitis, pyoderma, scarlet fever or invasive diseases, with potential for triggering post-infection immune sequelae. […] Fluctuating global GAS epidemiology is characterized by the emergence of new GAS clones, often associated with the acquisition of new virulence or antimicrobial determinants that are better adapted to the infection niche or averting host immunity. […] The recent identification of clinical GAS isolates with reduced penicillin sensitivity and increasing macrolide resistance threatens both frontline and penicillin-adjunctive antibiotic treatment. […] The World Health Organization (WHO) has developed a GAS research and technology road map and has outlined preferred vaccine characteristics, stimulating renewed interest in the development of safe and effective GAS vaccines. […] This paper is a comprehensive epidemiological analysis of the global health burden of GAS diseases.

• #65 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  A global consortium of Group A Streptococcus (Strep A) researchers has launched a series of best practice surveillance protocols designed to unite international research efforts for a world-first Strep A vaccine. […] The Strep A Vaccine Global Consortium (SAVAC), based at the International Vaccine Institute, spear-headed the protocol development to provide clear case definitions for diseases caused by Strep A and guide researchers with the design and planning of clinical trials measuring vaccine efficacy and safety. […] The new protocols are designed to be used for Strep A surveillance studies throughout the globe, making sure that research studies can be compared with each other, and that results from different populations and different studies can be compiled and analysed together. […] Co-Chair of the SAVAC Burden of Disease Working Group that oversaw these protocols, Dr Chris Van Beneden from the US CDC Foundation, said a key aspect of robust surveillance for Strep A involves generating updated regional disease burden estimates and developing platforms for future impact evaluation.

• #66 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  A global consortium of Group A Streptococcus (Strep A) researchers has launched a series of best practice surveillance protocols designed to unite international research efforts for a world-first Strep A vaccine. […] The Strep A Vaccine Global Consortium (SAVAC), based at the International Vaccine Institute, spear-headed the protocol development to provide clear case definitions for diseases caused by Strep A and guide researchers with the design and planning of clinical trials measuring vaccine efficacy and safety. […] The new protocols are designed to be used for Strep A surveillance studies throughout the globe, making sure that research studies can be compared with each other, and that results from different populations and different studies can be compiled and analysed together. […] Co-Chair of the SAVAC Burden of Disease Working Group that oversaw these protocols, Dr Chris Van Beneden from the US CDC Foundation, said a key aspect of robust surveillance for Strep A involves generating updated regional disease burden estimates and developing platforms for future impact evaluation.

• #67 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  A global consortium of Group A Streptococcus (Strep A) researchers has launched a series of best practice surveillance protocols designed to unite international research efforts for a world-first Strep A vaccine. […] The Strep A Vaccine Global Consortium (SAVAC), based at the International Vaccine Institute, spear-headed the protocol development to provide clear case definitions for diseases caused by Strep A and guide researchers with the design and planning of clinical trials measuring vaccine efficacy and safety. […] The new protocols are designed to be used for Strep A surveillance studies throughout the globe, making sure that research studies can be compared with each other, and that results from different populations and different studies can be compiled and analysed together. […] Co-Chair of the SAVAC Burden of Disease Working Group that oversaw these protocols, Dr Chris Van Beneden from the US CDC Foundation, said a key aspect of robust surveillance for Strep A involves generating updated regional disease burden estimates and developing platforms for future impact evaluation.

• #68

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  WHO recommends continued close analysis of the epidemiological situation in countries throughout the European region, which will be critical to assess ongoing risk and to adjust risk management measures in a timely manner. […] WHO encourages countries to undertake public health communication activities and messaging to healthcare providers to ensure proper clinical assessment and diagnostic testing of patients with symptoms consistent with GAS infection, and prompt treatment of patients with GAS. […] Clusters of cases of iGAS should be reported to local, regional or national health authorities to prompt further investigation.

• #69

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  WHO recommends continued close analysis of the epidemiological situation in countries throughout the European region, which will be critical to assess ongoing risk and to adjust risk management measures in a timely manner. […] WHO encourages countries to undertake public health communication activities and messaging to healthcare providers to ensure proper clinical assessment and diagnostic testing of patients with symptoms consistent with GAS infection, and prompt treatment of patients with GAS. […] Clusters of cases of iGAS should be reported to local, regional or national health authorities to prompt further investigation.

• #70

  https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429

  WHO recommends continued close analysis of the epidemiological situation in countries throughout the European region, which will be critical to assess ongoing risk and to adjust risk management measures in a timely manner. […] WHO encourages countries to undertake public health communication activities and messaging to healthcare providers to ensure proper clinical assessment and diagnostic testing of patients with symptoms consistent with GAS infection, and prompt treatment of patients with GAS. […] Clusters of cases of iGAS should be reported to local, regional or national health authorities to prompt further investigation.

• #71 Invasive Group A Streptococcal Disease: a Resurging Menace?

  https://www.cepheid.com/en-US/insights/insight-hub/tech-disease-trends/2024/11/invasive-group-streptococcal-disease.html

  Enhanced surveillance and timely reporting are crucial for the early detection and control of iGAS outbreaks. Clinicians should vigilantly monitor for signs and symptoms of severe GAS infections, especially in high-risk populations: children and the elderly, immunocompromised people, and those with chronic diseases. They should also report case clusters to public health authorities promptly to facilitate outbreak investigations and implement control measures. […] Considering the epidemiological links between GAS and iGAS, it can be hypothesized that addressing GAS pharyngitis through early detection and intervention would lower the total GAS burden and, in turn, reduce the potential for invasive infections.

• #72 Invasive Group A Streptococcal Disease: a Resurging Menace?

  https://www.cepheid.com/en-US/insights/insight-hub/tech-disease-trends/2024/11/invasive-group-streptococcal-disease.html

  Enhanced surveillance and timely reporting are crucial for the early detection and control of iGAS outbreaks. Clinicians should vigilantly monitor for signs and symptoms of severe GAS infections, especially in high-risk populations: children and the elderly, immunocompromised people, and those with chronic diseases. They should also report case clusters to public health authorities promptly to facilitate outbreak investigations and implement control measures. […] Considering the epidemiological links between GAS and iGAS, it can be hypothesized that addressing GAS pharyngitis through early detection and intervention would lower the total GAS burden and, in turn, reduce the potential for invasive infections.

• #73 Universal protocols for Strep A surveillance set to transform research for world-first vaccine

  https://www.thekids.org.au/news–events/news-and-events-nav/2022/september/protocols-for-strep-a-surveillance/

  Given that the disease spectrum associated with Strep A is broad and complex, accurately estimating the global burden of disease is challenging. In particular, current estimates underrepresent the extent of disease in low-and middle-income countries, Dr Van Beneden said. […] With vaccine development gaining momentum, backed up by the 2018 World Health Assembly adoption of a global resolution on ARF and RHD we envisage these protocols will provide a much clearer picture of mortality and infection rates, unite global research activities and accelerate our combined efforts for a world-first Strep A vaccine.

• #74 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  A key epidemiological feature of invasive S. pyogenes disease is its occurrence in individuals with no identified risk factors or predisposing conditions, which occurs in around 20-30% of all invasive S. pyogenes cases. […] The introduction of novel strains within a population has long been demonstrated as a cause of upsurge in S. pyogenes disease incidence, with the advancement of whole genome sequencing providing evidence for this phenomenon. […] The role of the environment in facilitating the spread of S. pyogenes is potentially under-recognized, despite well-documented accounts supporting its role in facilitating disease transmission. […] The molecular surveillance of S. pyogenes recovered from human infections worldwide is therefore crucial for providing information on possible shifts in clone prevalence with an impact on vaccine development, as well as for the early detection of clones with enhanced virulence, transmission, or antimicrobial resistance.

• #75 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  A key epidemiological feature of invasive S. pyogenes disease is its occurrence in individuals with no identified risk factors or predisposing conditions, which occurs in around 20-30% of all invasive S. pyogenes cases. […] The introduction of novel strains within a population has long been demonstrated as a cause of upsurge in S. pyogenes disease incidence, with the advancement of whole genome sequencing providing evidence for this phenomenon. […] The role of the environment in facilitating the spread of S. pyogenes is potentially under-recognized, despite well-documented accounts supporting its role in facilitating disease transmission. […] The molecular surveillance of S. pyogenes recovered from human infections worldwide is therefore crucial for providing information on possible shifts in clone prevalence with an impact on vaccine development, as well as for the early detection of clones with enhanced virulence, transmission, or antimicrobial resistance.

• #76 Epidemiology of Streptococcus pyogenes – Streptococcus pyogenes: Basic Biology to Clinical Manifestations – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK587100/

  A key epidemiological feature of invasive S. pyogenes disease is its occurrence in individuals with no identified risk factors or predisposing conditions, which occurs in around 20-30% of all invasive S. pyogenes cases. […] The introduction of novel strains within a population has long been demonstrated as a cause of upsurge in S. pyogenes disease incidence, with the advancement of whole genome sequencing providing evidence for this phenomenon. […] The role of the environment in facilitating the spread of S. pyogenes is potentially under-recognized, despite well-documented accounts supporting its role in facilitating disease transmission. […] The molecular surveillance of S. pyogenes recovered from human infections worldwide is therefore crucial for providing information on possible shifts in clone prevalence with an impact on vaccine development, as well as for the early detection of clones with enhanced virulence, transmission, or antimicrobial resistance.

• #77 Community outbreaks of group A Streptococcus revealed by genome sequencing | Scientific Reports

  https://www.nature.com/articles/s41598-017-08914-x

  The use of WGS in routine practice will require access to contextual genome databases, to enable comparison of outbreak isolates with circulating lineages. […] There is currently a paucity of population-based genomic surveillance of GAS and associated sequence data. […] The presence of clusters of highly similar isolates with no link to healthcare is indicative of cryptic community transmission. […] We have identified that even within localized populations there can be both diverse and closely related isolates, indicating both locally circulating clones and the introduction of new lineages. […] By monitoring local bacterial populations with WGS, informed by circulating national and international genomic data isolates, community transmission could be rapidly identified and interventions put in place.

• #78 Community outbreaks of group A Streptococcus revealed by genome sequencing | Scientific Reports

  https://www.nature.com/articles/s41598-017-08914-x

  The use of WGS in routine practice will require access to contextual genome databases, to enable comparison of outbreak isolates with circulating lineages. […] There is currently a paucity of population-based genomic surveillance of GAS and associated sequence data. […] The presence of clusters of highly similar isolates with no link to healthcare is indicative of cryptic community transmission. […] We have identified that even within localized populations there can be both diverse and closely related isolates, indicating both locally circulating clones and the introduction of new lineages. […] By monitoring local bacterial populations with WGS, informed by circulating national and international genomic data isolates, community transmission could be rapidly identified and interventions put in place.

• #79 Time to Strep up surveillance? | Microbiology Society

  https://microbiologysociety.org/blog/time-to-strep-up-surveillance.html

  In 2022-23, we saw a dramatic and sudden upsurge of scarlet fever. […] We argue there is significant potential value in surveillance of non-invasive isolates between upsurges; monitoring this vast reservoir of infection allows us to better understand StrepA tissue tropism, characterise new and emergent sublineages and identify changes in pathogenic potential. […] StrepA continues to pose an incredible challenge at the intersection of clinical medicine, molecular microbiology, public health, and global health. […] We’re excited to continue our future work in this field, with plans to apply our findings in genotype-to-phenotype infection models, expand our study of tissue tropism, and to explore optimal StrepA surveillance strategies.

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