More children than usual have died this year from an infection with group A streptococci (GAS), bacteria that can lead to severe pneumonia, blood poisoning or subcutaneous infections, among other things. The Juliana Children’s Hospital in The Hague reported last week that 61 children had been admitted to seven hospitals with severe GAS infections since last summer. Five of them did not survive.
According to the RIVM, at least eight children have died in the Netherlands this year so far. After a spring peak, there has been an increase since October. The number of reports of seriously ill children up to the age of five is almost four times higher than in previous years. The World Health Organization (WHO) is also seeing a resurgence of what is also known as the scarlet fever bacterium in other European countries.
1 What are group A streptococci?
Group A streptococci (GAS) are bacteria that often go unnoticed. Many people walk around with it without getting sick. You may get relatively mild ailments, such as laryngitis, scarlet fever or impetigo. In rare cases, an infection leads to something worse, such as severe pneumonia, blood poisoning or meningitis. Pregnant women can get puerperal fever after giving birth. But now it is striking that it is primarily young children who become very ill.
2 How many children are there?
It is hard to say. Doctors only have to report three of the approximately fifteen syndromes caused by a GAS infection to the RIVM: puerperal fever, toxic shock syndrome and severe subcutaneous infections. The 38 young children with GAS infections reported there until mid-December are therefore the tip of the iceberg. The seven hospitals in the Juliana Children’s Hospital study already had 28 children in the second quarter alone with a greater variety of serious infections.
3 What do these kids have?
“These are very different pictures,” says pediatrician Mirjam van Veen from Juliana Children’s Hospital. “We see most children with complicated pneumonia, as well as blood poisoning and subcutaneous infections. These are very serious illnesses.” About a third of the children ended up in intensive care.
4 How can the increase be explained?
Doctors usually see more ‘strep A’ in the spring when it gets warmer, often after a flu outbreak. A peak in autumn and winter is unusual, according to experts in the magazine Nature. One explanation could be that children have built up less immunity during the shutdowns due to a lack of social interaction. Viruses such as influenza and RSV also spread faster. In the United Kingdom, a revival of GAD can be seen in scarlet fever figures. Scarlet fever (fever, sore throat, rough spots on the skin in children) is caused by GAD and is almost four times more common this year.
5 Are group A streptococcus suddenly more contagious?
More variants have been seen in children this year, says Professor of Translational Microbiology Nina van Sorge (Amsterdam UMC). There is a dominant variant, but there does not appear to be a new superbug that is making children more often and more seriously ill. “In the 1980s, more invasive varieties appeared. But I have yet to see any studies that suggest that.”
Despite all the different varieties that you can get sick from again and again, children gradually build up immunity until they are almost adults. They get scarlet fever less often after the age of six.
6 Why do some children get sicker than others?
“Children who already have a viral infection are more susceptible to this type of bacterial infection,” says Van Sorge. In the case of chicken pox, influenza and respiratory infections, the general practitioners pay extra attention. There are good antibiotics to fight group A streptococci. “But the problem is that the disease progresses very quickly.” In rare cases, antibiotics come too late.
The problem is that you only see group A streptococcus when you culture them, and the syndromes vary so much. Van Veen: “There are many children with a fever who have nothing serious, but if a child is drowsy, short of breath or less lively, that is a reason to seek medical attention.”
7 Is there a vaccine against group A streptococcus?
We have been working on it for years, says Van Sorge. She points out that 700 million people worldwide get sick from this bacteria every year, with as many deaths as the flu. She has therefore for some time called for attention to group A streptococci. “One of the reasons why it is complicated to develop a vaccine is that after a GAS infection, defenses also arise against the body, and you don’t want a vaccine to trigger autoimmune diseases.” Van Sorge believes that a vaccine will be at least ten years away.