6475 Understanding health pathways of children with invasive group a streptococcus (iGAS) infections in North West London 2017–2023: a retrospective cohort study

Objectives Group A Streptococcus (GAS) infections cause a spectrum of illness from mild infections to severe invasive Group A Streptococcal (iGAS) disease, associated with high morbidity and mortality. Early recognition and treatment for cases of iGAS is potentially lifesaving. A considerable number of children with severe infections are seen by a healthcare professional prior to hospital admission, highlighting difficulties in the early recognition of children at high risk for severe infections. In autumn 2022, clinicians in the UK saw a notable increase in conditions associated with iGAS, out of keeping with the usual seasonal variation.¹ We aimed to further understand the healthcare pathways of children with iGAS in North West (NW) London and to describe the number and types of visits to healthcare professionals prior to a diagnosis of iGAS, to gain insight into opportunities to predict the risk of severe infection. Methods Retrospective analysis of a NW London deidentified database of integrated care records for a cohort of approximately 450,000 children aged 0–16 years, defined by index admission to hospital. Children were allocated into groups of 'likely iGAS' and 'possible iGAS', based on ICD-10 codes, defined by a group of paediatric infectious disease specialists. Results Between 1st January 2017- 19th September 2023, 173 children were admitted to hospital with 'likely iGAS' and 55 with 'possible iGAS'. As expected, there was an increase in the number of cases of 'likely iGAS' in autumn 2022- spring 2023 (figure 1). Of children with 'likely iGAS', 58.4% were male and 60.1% were aged 0–5 years old. Of children with 'likely iGAS', 145(83.8%) had contact with primary care and 15(8.7%) received an antibiotic prescription from primary care in the 14 days preceding their diagnosis. Of children with 'possible iGAS', 41(74.5%) had contact with primary care and 9(16.4%) received an antibiotic prescription from primary care in the 14 days preceding their diagnosis. Between November 2022- April 2023, 7.9% of children with 'likely iGAS' and 33.3% of children with 'possible iGAS' received an antibiotic prescription from primary care in the 14 days preceding their diagnosis. Conclusion Over 80% of children with 'likely iGAS' had contact with a primary care healthcare professional in the 14 days preceding their diagnosis, however only 8.7% received an antibiotic prescription. This demonstrates the difficulties in recognising children at risk of severe infection at first presentation to a healthcare professional. Further work is now being conducted to analyse patterns of iGAS infections over time. Reference Bamford A, Whittaker E. Resurgence of group A streptococcal disease in children. BMJ [Internet] 2023;380. Available from: https://www.bmj.com/content/380/bmj.p43