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DGS-URGENT
DATE: 06/12/2022 REFERENCE: DGS-URGENT N°2022_83
SUBJECT: RECRUDESCENCE OF INVASIVE STREPTOCOCAL A INFECTIONS
...
Ladies and gentlemen,
Several pediatric cases of invasive Group A Streptococcal (IISGA) infections, in greater numbers
than usual, have been reported in different regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) in
course of the last 15 days. These cases led to the hospitalization in intensive care of at least 8 children without risk factors.
risk identified, of which 2 died. Three adult cases have been reported of which 1 died.
The provisional results of the epidemiological investigations carried out by Santé Publique France (SpF) and the characterization
strains by the National Reference Center (CNR) for streptococci suggest that these cases have no link between
them and that these reports are probably not due to the emergence of a more virulent strain but rather to a
unusual increase in the number of cases, linked to different strains.
The observations of certain resuscitation health professionals and pediatric emergencies are part of this
trend, with reports of an upsurge in serious forms and deaths (laryngitis/pleuropneumopathies, arrests
sudden unexplained cardio-respiratory symptoms evocative of streptococcal toxic shock) following an infection with
streptococcus A in several children, for a few weeks.
Separately, the UK has also reported an upsurge in cases in recent days with the occurrence of at least
6 deaths in children.
Investigations are underway by SpF and the CNR in conjunction with the laboratories of the “EPIBAC” hospital network to
to objectify and describe more precisely the multiplication of cases of IISGA at the national level and to specify the situation
international epidemiology.
Pending clarification of this situation, we thank you for paying attention to the following points:
- Perform a Rapid Diagnostic Orientation Test (TROD) Streptococcus A in the face of angina and a
throat swab in the face of a clinical picture of scarlet fever, in the event of a negative TROD. Scarlet fever is
the mild form of a streptococcal infection. It is a clinical diagnosis and a negative TROD is not sufficient to
exclude a streptococcal A infection. They can progress to more severe and sometimes resuscitative forms
constituting toxic shock syndrome;
- Remind your patients of the importance of barrier measures in this winter season;
- Report without delay to your ARS any case of serious invasive streptococcal A infection (i.e. requiring
hospitalization);
- To systematically send to the CNR the positive strains or samples of cases of invasive infections
group A streptococcus.
With regard to the eviction of cases of streptococcus A from the community, it must continue until 2 days after the start
antibiotic therapy. The importance of respecting barrier measures within the community must be recalled.
With regard to the identification of contact persons, the current course of action recommends the prescription of a
systemic antibiotic prophylaxis for contact subjects with a risk factor for developing an invasive infection (age
over 65 years old, progressive varicella, extensive skin lesions, IV drug addiction, progressive pathology, significant intake
oral corticosteroids). In view of the seriousness of the cases on the one hand, and the occurrence of hospitalizations in
resuscitation of contact persons in the family circle of patients, it is necessary to monitor the appearance of
any clinical sign in the patient's environment in order to allow early diagnosis and treatment.
A referral to learned societies is in progress to specify the recommendations for the management of cases and
contact persons, particularly in the current context of tensions over amoxicillin.
We thank you for your mobilization and we will keep you informed of any changes in the situation or
recommendations.
More about this source textSource text required for additional translation information
Send feedback
Side panels
Pr. Jérôme SALOMON
Director General of the
Health
https://solidarites-sante.gouv.fr/IM...ptocoque_a.pdf
----------------------------------------------
Invasive Group A Streptococcal Infection (IISGA): update as of December 6, 2022
Update following several pediatric cases of invasive group A streptococcal infections mainly occurring in children under 10 years of age in several regions in France.
Posted on December 6, 2022
Over the past two weeks, pediatric clinicians and resuscitators have reported to Public Health France and the Regional Health Agencies (ARS) a higher than usual number of pediatric cases of invasive Group A Streptococcal (IISGA) infections. their services. The CNR has also observed since the beginning of 2022 an increase in the proportion of pediatric strains and since the summer of 2022 an increase in the number of strains of invasive pediatric infections compared to previous years.
These invasive group A streptococcal infections (IISGA) occurred in different regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) and mainly in children under 10 years old. As part of its surveillance and alert missions, Public Health France, in conjunction with its partners, is strengthening the surveillance of these infections.
Invasive group A streptococcal infections in France
GAS is a strictly human pathogen that is transmitted by respiratory droplets and direct contact (nasal secretions, skin lesions, etc.). It is most often responsible for mild non-invasive infections, such as angina, impetigo and scarlet fever. More rarely, it is responsible for serious invasive infections (necrotizing skin infections, puerperal infections, pneumopathies and pleuropneumopathies and meningitis) which may be associated with streptococcal toxic shock syndrome (STSS).
To limit the risk of transmission, it is advisable to adopt the same barrier gestures used against winter viruses:
Active surveillance is set up by Public Health France and the GFRUP (Francophone Group for Resuscitation and Pediatric Emergencies) in order to complete the already existing surveillance system, to better assess the situation on the epidemiological level and to characterize the severe forms admitted. in intensive care. The protocol for this surveillance will soon be published on our website.
This collection of data complements the microbiological monitoring of streptococci A which is carried out by the National Reference Center for Streptococci, as well as that of the EPIBAC network . The SGA strains transmitted to the CNR by the bacteriology laboratories are characterized there, in particular at the genotypic level.
As a reminder, the monitoring of invasive infections, including those linked to group A Streptococcus ( Streptococcus pyogenes ) carried out by Public Health France, is based on the EPIBAC network, whose objective is to estimate the incidence of invasive infections in France, to monitor their evolution over time and describe the main epidemiological characteristics of hospitalized patients.
Data from the EPIBAC network show that invasive GAS infections were constantly increasing between 2003 and 2019. Over this period, they affected approximately 1,500 to 2,500 people each year, nearly 10% of whom were children under the age of 10. In 2020, the incidence of these infections was decreasing and this trend continued in 2021.
To know more :
https://www.santepubliquefrance.fr/l...-decembre-2022
DGS-URGENT
DATE: 06/12/2022 REFERENCE: DGS-URGENT N°2022_83
SUBJECT: RECRUDESCENCE OF INVASIVE STREPTOCOCAL A INFECTIONS
...
Ladies and gentlemen,
Several pediatric cases of invasive Group A Streptococcal (IISGA) infections, in greater numbers
than usual, have been reported in different regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) in
course of the last 15 days. These cases led to the hospitalization in intensive care of at least 8 children without risk factors.
risk identified, of which 2 died. Three adult cases have been reported of which 1 died.
The provisional results of the epidemiological investigations carried out by Santé Publique France (SpF) and the characterization
strains by the National Reference Center (CNR) for streptococci suggest that these cases have no link between
them and that these reports are probably not due to the emergence of a more virulent strain but rather to a
unusual increase in the number of cases, linked to different strains.
The observations of certain resuscitation health professionals and pediatric emergencies are part of this
trend, with reports of an upsurge in serious forms and deaths (laryngitis/pleuropneumopathies, arrests
sudden unexplained cardio-respiratory symptoms evocative of streptococcal toxic shock) following an infection with
streptococcus A in several children, for a few weeks.
Separately, the UK has also reported an upsurge in cases in recent days with the occurrence of at least
6 deaths in children.
Investigations are underway by SpF and the CNR in conjunction with the laboratories of the “EPIBAC” hospital network to
to objectify and describe more precisely the multiplication of cases of IISGA at the national level and to specify the situation
international epidemiology.
Pending clarification of this situation, we thank you for paying attention to the following points:
- Perform a Rapid Diagnostic Orientation Test (TROD) Streptococcus A in the face of angina and a
throat swab in the face of a clinical picture of scarlet fever, in the event of a negative TROD. Scarlet fever is
the mild form of a streptococcal infection. It is a clinical diagnosis and a negative TROD is not sufficient to
exclude a streptococcal A infection. They can progress to more severe and sometimes resuscitative forms
constituting toxic shock syndrome;
- Remind your patients of the importance of barrier measures in this winter season;
- Report without delay to your ARS any case of serious invasive streptococcal A infection (i.e. requiring
hospitalization);
- To systematically send to the CNR the positive strains or samples of cases of invasive infections
group A streptococcus.
With regard to the eviction of cases of streptococcus A from the community, it must continue until 2 days after the start
antibiotic therapy. The importance of respecting barrier measures within the community must be recalled.
With regard to the identification of contact persons, the current course of action recommends the prescription of a
systemic antibiotic prophylaxis for contact subjects with a risk factor for developing an invasive infection (age
over 65 years old, progressive varicella, extensive skin lesions, IV drug addiction, progressive pathology, significant intake
oral corticosteroids). In view of the seriousness of the cases on the one hand, and the occurrence of hospitalizations in
resuscitation of contact persons in the family circle of patients, it is necessary to monitor the appearance of
any clinical sign in the patient's environment in order to allow early diagnosis and treatment.
A referral to learned societies is in progress to specify the recommendations for the management of cases and
contact persons, particularly in the current context of tensions over amoxicillin.
We thank you for your mobilization and we will keep you informed of any changes in the situation or
recommendations.
More about this source textSource text required for additional translation information
Send feedback
Side panels
Pr. Jérôme SALOMON
Director General of the
Health
https://solidarites-sante.gouv.fr/IM...ptocoque_a.pdf
----------------------------------------------
Invasive Group A Streptococcal Infection (IISGA): update as of December 6, 2022
Update following several pediatric cases of invasive group A streptococcal infections mainly occurring in children under 10 years of age in several regions in France.
Posted on December 6, 2022
Over the past two weeks, pediatric clinicians and resuscitators have reported to Public Health France and the Regional Health Agencies (ARS) a higher than usual number of pediatric cases of invasive Group A Streptococcal (IISGA) infections. their services. The CNR has also observed since the beginning of 2022 an increase in the proportion of pediatric strains and since the summer of 2022 an increase in the number of strains of invasive pediatric infections compared to previous years.
These invasive group A streptococcal infections (IISGA) occurred in different regions (Occitanie, Auvergne-Rhône-Alpes, Nouvelle-Aquitaine) and mainly in children under 10 years old. As part of its surveillance and alert missions, Public Health France, in conjunction with its partners, is strengthening the surveillance of these infections.
Invasive group A streptococcal infections in France
GAS is a strictly human pathogen that is transmitted by respiratory droplets and direct contact (nasal secretions, skin lesions, etc.). It is most often responsible for mild non-invasive infections, such as angina, impetigo and scarlet fever. More rarely, it is responsible for serious invasive infections (necrotizing skin infections, puerperal infections, pneumopathies and pleuropneumopathies and meningitis) which may be associated with streptococcal toxic shock syndrome (STSS).
To limit the risk of transmission, it is advisable to adopt the same barrier gestures used against winter viruses:
- hand washing,
- wearing a mask for people with respiratory infections,
- sneeze or cough into the bend of the elbow.
Active surveillance is set up by Public Health France and the GFRUP (Francophone Group for Resuscitation and Pediatric Emergencies) in order to complete the already existing surveillance system, to better assess the situation on the epidemiological level and to characterize the severe forms admitted. in intensive care. The protocol for this surveillance will soon be published on our website.
This collection of data complements the microbiological monitoring of streptococci A which is carried out by the National Reference Center for Streptococci, as well as that of the EPIBAC network . The SGA strains transmitted to the CNR by the bacteriology laboratories are characterized there, in particular at the genotypic level.
As a reminder, the monitoring of invasive infections, including those linked to group A Streptococcus ( Streptococcus pyogenes ) carried out by Public Health France, is based on the EPIBAC network, whose objective is to estimate the incidence of invasive infections in France, to monitor their evolution over time and describe the main epidemiological characteristics of hospitalized patients.
Data from the EPIBAC network show that invasive GAS infections were constantly increasing between 2003 and 2019. Over this period, they affected approximately 1,500 to 2,500 people each year, nearly 10% of whom were children under the age of 10. In 2020, the incidence of these infections was decreasing and this trend continued in 2021.
To know more :
https://www.santepubliquefrance.fr/l...-decembre-2022