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September 10, 2025

Severe Group A Streptococcus Infection among Children, France, 2022–2024

Key Points

Severe respiratory tract infections occurred in 55% of cases among children with group A streptococcus infections.
The study included 402 pediatric patients, with a notable case-fatality rate of 3.5%, highlighting serious health risks.
Molecular analysis identified the emm1 strain in 73% of cases, with the M1UK clone making up half of those strains detected.
Multivariate analysis showed that hydrocortisone and corticosteroid treatments were significantly linked to major sequelae or death in patients.

Abstract

Group A Streptococcus infections have increased in Europe since September 2022. The French Pediatric Intensive Care and French Pediatric Infectious Diseases expert groups conducted a retrospective and prospective study of children who had severe group A Streptococcus infections during September 1, 2022-April 1, 2024, across 34 hospitals in France. A total of 402 pediatric patients (median age 4 interquartile range 2-7.5 years; 42% girls, 58% boys) were enrolled. Cases were characterized by a low proportion of severe skin and soft tissue infections (16%), predominance of severe upper and lower respiratory tract infections (55%), and a 3.5% case-fatality rate. In multivariate analysis, hydrocortisone, corticosteroid, and vasopressor therapies were significantly associated with major sequelae or death. Molecular analysis revealed emm1 (73.0%) and emm12 (10.8%) strains; the M1UK clone represented 50% of emm1 strains. Clinicians, researchers, and public health authorities must collaborate to mitigate the effects of GAS on child health.

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