Streptococcus does not only threaten children - How many adults have lost their lives in Greece?

From the beginning of 2023 to January 11, 2024, 89 cases and 22 deaths have been recorded, 12 of which in adults

The National Public Health Organization (EODY) has sounded the alarm about escalating invasive group A Streptococcus (Invasive Group A Streptococcus, iGAS) cases in children and adults in Europe and Greece.

As stated in the newsletter, due to the increase in cases worldwide, their registration also began in Greece at the beginning of 2023. From the beginning of the year 2023 until January 11, 2024 (week 2), the following have been declared to EODY:

Eighty-nine cases of iGAS, 40 in adults and 49 in children, mostly under ten years of age.
among the incidents, 22 deaths, 10 in children aged 12 months to eight years and 12 in adults, mostly with underlying diseases

Graph. Number of laboratory-confirmed cases and deaths of patients with invasive group A streptococcal (iGAS) infection by week of onset of symptoms (ISO week), Greece, data 1/1/2023-11/1/2024.

What is the reason for the increase?

According to EODY, the recorded increase in iGAS cases followed a reduced frequency of group A strep infections observed during the COVID-19 pandemic.

The increase in cases in children may be related to the recent increased circulation of respiratory viruses such as seasonal influenza virus and respiratory syncytial virus (RSV), as co-infection with group A virus and streptococcus may raise the risk of invasive disease from iGAS.

What is group A streptococcus?

Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis in school-age children.

The clinical picture includes a sore throat, fever, headache, and, in some cases, a confluent erythematous rash due to one or more erythrogenic toxins (scarring). GAS pharyngitis is diagnosed with a rapid antigen detection test (strep test) and throat swab culture and is treated with antibiotics.

In rare cases, group A streptococcus can manifest as an invasive infection, initially with non-specific symptoms (fever, general fatigue, loss of appetite). Especially in children, it can rapidly progress to severe and life-threatening.

The clinical picture of an iGAS case can present as bacteremia, pneumonia, skin and bone infection, meningitis, cellulitis, osteomyelitis, necrotising fasciitis, streptococcal toxic shock, etc.

Points of caution

Parents of children and school staff should be aware of the suspected symptoms of GAS and iGAS infection and the importance of seeking prompt medical advice within the first twenty-four hours of the onset of symptoms.

iGAS infection should be included in the differential diagnosis of children with a severe respiratory infection, a previous viral illness (including influenza and chickenpox), and in persons who are in close contact with a case of streptococcal tonsillitis or scarlet fever.

Early recognition of iGAS infection and prompt antimicrobial and supportive therapy initiation for affected children is extremely important for a favourable disease outcome.

Also, close contacts of iGAS cases should be identified, their condition assessed and treated according to the guidelines posted on the EODY website.

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