tetano
Editor, Senior Moderator
Lancet Reg Health Eur
. 2025 Oct 18:59:101497.
doi: 10.1016/j.lanepe.2025.101497. eCollection 2025 Dec. Paediatric invasive group A streptococcal infections and associations with viral infections in 15 European countries after lifting non-pharmaceutical interventions against SARS-CoV-2: an interrupted time-series analysis
Léa Lenglart[SUP] 1 2 [/SUP], Izel Özmen[SUP] 3 4 [/SUP], David Aguilera-Alonso[SUP] 5 [/SUP], Daniel Blazquez-Gamero[SUP] 6 [/SUP], Navin P Boeddha[SUP] 7 [/SUP], Emilie Pauline Buddingh[SUP] 8 [/SUP], Danilo Buonsenso[SUP] 9 10 [/SUP], Cristina Calvo[SUP] 11 [/SUP], Riccardo Castagnoli[SUP] 12 13 [/SUP], Marta Daina[SUP] 14 [/SUP], Maria-Myrto Dourdouna[SUP] 15 [/SUP], Marieke Emonts[SUP] 16 17 [/SUP], Carmen Ezinwoke[SUP] 16 [/SUP], Catarina Gouveia[SUP] 18 [/SUP], David Grandioso Vas[SUP] 11 [/SUP], Jeroen Hol[SUP] 3 [/SUP], Mette Holm[SUP] 19 [/SUP], Christian R Kahlert[SUP] 20 [/SUP], Benno Kohlmaier[SUP] 21 [/SUP], Kamila Ludwikowska[SUP] 22 [/SUP], Gian Luigi Marseglia[SUP] 12 13 [/SUP], Andrew McArdle[SUP] 23 [/SUP], Rachel McGalliard[SUP] 23 [/SUP], Athanasios Michos[SUP] 15 [/SUP], Anda Nagle[SUP] 14 [/SUP], Anita Niederer-Loher[SUP] 20 [/SUP], Ulrikka Nygaard[SUP] 24 [/SUP], Rianne Oostenbrink[SUP] 4 [/SUP], Tina Plankar Srovin[SUP] 25 [/SUP], Sandrine Roisin[SUP] 26 [/SUP], Jesús Saavedra-Lozano[SUP] 5 [/SUP], Adriana Shan[SUP] 6 [/SUP], Valtyr Stefansson Thors[SUP] 27 [/SUP], Volker Strenger[SUP] 21 [/SUP], Angeliki Syngelou[SUP] 28 [/SUP], Anne Tilmanne[SUP] 26 [/SUP], Monika Tokarczyk[SUP] 22 [/SUP], Christo Tsilifis[SUP] 16 [/SUP], Maria Tsolia[SUP] 28 [/SUP], Adam Tulling[SUP] 8 [/SUP], Evelien van Kempen[SUP] 29 [/SUP], Mirjam Van Veen[SUP] 29 [/SUP], Katarina Vincek[SUP] 25 [/SUP], Ulrich Von Both[SUP] 30 [/SUP], Dace Zavadska[SUP] 14 [/SUP], Mohammed Zaman[SUP] 31 [/SUP], Ruud G Nijman[SUP] 31 32 [/SUP], Naim Ouldali[SUP] 2 33 [/SUP], Dorine Borensztajn[SUP] 3 4 [/SUP]; PEGASUS Consortium
Collaborators, Affiliations
Background: After lifting non-pharmaceutical interventions (NPIs) against the transmission of SARS-CoV-2, various countries experienced an increase in invasive Group A Streptococcal (iGAS) infections. We aimed to characterise the paediatric outbreak across Europe and to analyse the influence of viral infections.
Methods: We conducted an interrupted time-series analysis based on data from 15 European countries from the PEGASUS consortium. We assessed the evolution of the number of iGAS cases aged 1 month to 18 years between 01/01/2018 and 03/31/2024, comparing the post-NPIs period (01-04-2022 until 31-03-2024) to the baseline period (01-01-2018 until 31-03-2020). Further analyses were performed by country, clinical phenotype, age and severity, including sensitivity analyses. We then explored whether certain iGAS phenotypes correlated with trends in RSV, influenza and VZV across countries over time using Google Trends data.
Findings: We included 2091 iGAS cases over the study period; 79 children (3.6%) died and 580 (27.7%) required PICU admission. We estimated an overall increase of +229.8% (95% CI (141.9-341.6)) among iGAS cases from October 2022 to March 2024, compared to the baseline period. The observed increases varied across clinical phenotypes, ranging from +62.7% (95% CI (8.3-157.9)) for osteo-articular infections to +238.7% (95% CI 75.8-464.8) for pneumonia. We observed a strong correlation between the incidence of iGAS pneumonia and RSV (Rho: 0.57, 95% CI [0.11-0.79]) and influenza (Rho 0.69, 95% CI 0.35-0.87); and between skin and soft tissue infections and VZV (Rho: 0.73, 95% CI [0.42-0.89]).
Interpretation: The patterns observed across Europe during this outbreak demonstrate an association between respiratory viruses as well as VZV, and iGAS.
Funding: This study has received funding from ESPID, INOPSU and the Northwest Clinics. The COPP study group was supported by grants of the Dutch National Health Council (ZonMW) project number 10430072110007 and the Christine Bader Foundation.
Keywords: Europe; Flu; Group A streptococcus; Immunity debt; Influenza; Invasive streptococcal disease; Non pharmaceutical interventions; Outbreak; Paediatrics; RSV; Respiratory syncytial virus; Streptococcus pyogenes; VZV; Varicella; Viral infections; Viruses.
. 2025 Oct 18:59:101497.
doi: 10.1016/j.lanepe.2025.101497. eCollection 2025 Dec. Paediatric invasive group A streptococcal infections and associations with viral infections in 15 European countries after lifting non-pharmaceutical interventions against SARS-CoV-2: an interrupted time-series analysis
Léa Lenglart[SUP] 1 2 [/SUP], Izel Özmen[SUP] 3 4 [/SUP], David Aguilera-Alonso[SUP] 5 [/SUP], Daniel Blazquez-Gamero[SUP] 6 [/SUP], Navin P Boeddha[SUP] 7 [/SUP], Emilie Pauline Buddingh[SUP] 8 [/SUP], Danilo Buonsenso[SUP] 9 10 [/SUP], Cristina Calvo[SUP] 11 [/SUP], Riccardo Castagnoli[SUP] 12 13 [/SUP], Marta Daina[SUP] 14 [/SUP], Maria-Myrto Dourdouna[SUP] 15 [/SUP], Marieke Emonts[SUP] 16 17 [/SUP], Carmen Ezinwoke[SUP] 16 [/SUP], Catarina Gouveia[SUP] 18 [/SUP], David Grandioso Vas[SUP] 11 [/SUP], Jeroen Hol[SUP] 3 [/SUP], Mette Holm[SUP] 19 [/SUP], Christian R Kahlert[SUP] 20 [/SUP], Benno Kohlmaier[SUP] 21 [/SUP], Kamila Ludwikowska[SUP] 22 [/SUP], Gian Luigi Marseglia[SUP] 12 13 [/SUP], Andrew McArdle[SUP] 23 [/SUP], Rachel McGalliard[SUP] 23 [/SUP], Athanasios Michos[SUP] 15 [/SUP], Anda Nagle[SUP] 14 [/SUP], Anita Niederer-Loher[SUP] 20 [/SUP], Ulrikka Nygaard[SUP] 24 [/SUP], Rianne Oostenbrink[SUP] 4 [/SUP], Tina Plankar Srovin[SUP] 25 [/SUP], Sandrine Roisin[SUP] 26 [/SUP], Jesús Saavedra-Lozano[SUP] 5 [/SUP], Adriana Shan[SUP] 6 [/SUP], Valtyr Stefansson Thors[SUP] 27 [/SUP], Volker Strenger[SUP] 21 [/SUP], Angeliki Syngelou[SUP] 28 [/SUP], Anne Tilmanne[SUP] 26 [/SUP], Monika Tokarczyk[SUP] 22 [/SUP], Christo Tsilifis[SUP] 16 [/SUP], Maria Tsolia[SUP] 28 [/SUP], Adam Tulling[SUP] 8 [/SUP], Evelien van Kempen[SUP] 29 [/SUP], Mirjam Van Veen[SUP] 29 [/SUP], Katarina Vincek[SUP] 25 [/SUP], Ulrich Von Both[SUP] 30 [/SUP], Dace Zavadska[SUP] 14 [/SUP], Mohammed Zaman[SUP] 31 [/SUP], Ruud G Nijman[SUP] 31 32 [/SUP], Naim Ouldali[SUP] 2 33 [/SUP], Dorine Borensztajn[SUP] 3 4 [/SUP]; PEGASUS Consortium
Collaborators, Affiliations
- PMID: 41170145
- PMCID: PMC12569802
- DOI: 10.1016/j.lanepe.2025.101497
Background: After lifting non-pharmaceutical interventions (NPIs) against the transmission of SARS-CoV-2, various countries experienced an increase in invasive Group A Streptococcal (iGAS) infections. We aimed to characterise the paediatric outbreak across Europe and to analyse the influence of viral infections.
Methods: We conducted an interrupted time-series analysis based on data from 15 European countries from the PEGASUS consortium. We assessed the evolution of the number of iGAS cases aged 1 month to 18 years between 01/01/2018 and 03/31/2024, comparing the post-NPIs period (01-04-2022 until 31-03-2024) to the baseline period (01-01-2018 until 31-03-2020). Further analyses were performed by country, clinical phenotype, age and severity, including sensitivity analyses. We then explored whether certain iGAS phenotypes correlated with trends in RSV, influenza and VZV across countries over time using Google Trends data.
Findings: We included 2091 iGAS cases over the study period; 79 children (3.6%) died and 580 (27.7%) required PICU admission. We estimated an overall increase of +229.8% (95% CI (141.9-341.6)) among iGAS cases from October 2022 to March 2024, compared to the baseline period. The observed increases varied across clinical phenotypes, ranging from +62.7% (95% CI (8.3-157.9)) for osteo-articular infections to +238.7% (95% CI 75.8-464.8) for pneumonia. We observed a strong correlation between the incidence of iGAS pneumonia and RSV (Rho: 0.57, 95% CI [0.11-0.79]) and influenza (Rho 0.69, 95% CI 0.35-0.87); and between skin and soft tissue infections and VZV (Rho: 0.73, 95% CI [0.42-0.89]).
Interpretation: The patterns observed across Europe during this outbreak demonstrate an association between respiratory viruses as well as VZV, and iGAS.
Funding: This study has received funding from ESPID, INOPSU and the Northwest Clinics. The COPP study group was supported by grants of the Dutch National Health Council (ZonMW) project number 10430072110007 and the Christine Bader Foundation.
Keywords: Europe; Flu; Group A streptococcus; Immunity debt; Influenza; Invasive streptococcal disease; Non pharmaceutical interventions; Outbreak; Paediatrics; RSV; Respiratory syncytial virus; Streptococcus pyogenes; VZV; Varicella; Viral infections; Viruses.