Background: From September 2022, global rates of invasive group A streptococcal (iGAS) disease surged, beyond pre-pandemic levels with atypical seasonality particularly affecting children. We previously described the epidemiology of iGAS from mid-2018 to end 2022 from the prospective Paediatric Active Enhanced Diseases network. Here, we update findings from beginning 2023 to end 2024, exploring resurgence patterns and ripple effects.
Methods: Patients 0 – 18 years with iGAS admitted to six tertiary hospitals in five Australian states/territories were included. Confirmed cases had GAS isolated from sterile sites; probable cases had septic shock, streptococcal toxic shock syndrome, or necrotising fasciitis and isolation of GAS from a non-sterile site.
Results: In 2023-2024, 354 cases were reported, peaking in 2023 (n = 262), higher than both 2022 (n = 129) and 2024 (n = 92). In 2023, incidence peaked in Q3, while in 2024 cases were evenly distributed (18–28 cases/quarter). Severe disease (ICU admission) occurred among 142 (40%) children with six deaths. At discharge, 128 (36%) had not returned to premorbid function. Respiratory co-infection was found in 115/251 (46%); of these 74 required ICU admission (64%). Prophylactic antibiotics were recommended to close contacts of 225 cases (64%).
Conclusion: Increased iGAS continued and peaked in 2023 in sentinel Australian paediatric hospitals. Case numbers in 2024 were comparable to pre-pandemic levels but showed more even seasonal distribution compared to pre-pandemic spring peaks. The significant disease burden highlights the need for continued public health efforts, monitoring, and vaccine development.
Submitted on behalf of the PAEDS Network.