Three Deaths in France Linked to Group A Strep Infections

Aude Lecrubier

December 28, 2022

The French Ministry of Health (MoH) has raised the alarm. Over the course of the last 2 weeks, at least eight children — none with identified risk factors — have been hospitalized after contracting an invasive group A streptococcal (iGAS) infection. Two of them have died. During the same period, there has been one death among the three adults hospitalized. 

As the Pasteur Institute's website notes, iGAS infections have been on the rise in France since 2000. Still, the number of severe cases is unusually high.

According to the French Public Health Agency, the regions affected by these cases are Occitania, Auvergne-Rhône-Alpes, and New Aquitaine. Across France, however, there has been a quite sudden increase in common diseases caused by group A Streptococcus bacteria such as strep throat, impetigo, and scarlet fever. They mostly are seen in children under age 10 years.

On December 6, Jérôme Salomon, MD, MPH, PhD, the MoH's director general for health (DGS), issued a DGS-Urgent message to all healthcare professionals in France, informing them that "Preliminary results of epidemiologic investigations carried out by the French Public Health Agency and of characterization of the strains by the National Reference Center for Streptococci (NRC-Strep) suggest that there is no link between these cases and that the reports are probably due not to the emergence of a more virulent strain, but rather to an unusual increase in the number of cases, in conjunction with different strains."

France is not the only country to see an increase in cases. In the United Kingdom, at least nine children have died in recent days, prompting professional societies to recommend that there be no hesitation in quickly prescribing antibiotics to suspected cases. For its part, the MoH concluded the DGS-Urgent message by noting that, in France, "a referral has been made to learned societies, which are now in the process of specifying the recommendations for managing the cases and the patients' close contacts, particularly in the context of the current strain on the supply of amoxicillin."

National and international investigations are underway to assess the situation.

Is Prevention Possible?

In the DGS-Urgent message, the MoH recommended that "a Rapid Strep Test (RST) be carried out on patients presenting with strep throat and that a throat swab be collected when the clinical picture indicates scarlet fever, should the RST come back negative." It explained that "scarlet fever is a benign infection caused by group A Streptococcus bacteria. It is a clinical diagnosis, and a negative RST is not sufficient to rule out a group A strep infection. Strep throat and scarlet fever may develop into more severe infections — sometimes requiring hospitalization in the ICU — which may be associated with streptococcal toxic shock syndrome."

The MoH goes on to ask the healthcare professionals to remind their patients about the importance of taking personal protective measures during the winter season.

Infected people should stay home from work or school for two days after starting antibiotic therapy.

For people who were in close contact with an infected person, it is advised that systematic prophylactic antibiotic treatment be prescribed to those at risk of developing an invasive infection. Risk factors include age older than 65 years, progressive chickenpox, extensive skin lesions, addiction to IV drugs, progressive disease, and significant intake of oral corticosteroids.

The DGS-Urgent message continued, "In view of, on the one hand, the severity of the cases and, on the other, the fact that close contacts within the patients' family circles are being hospitalized in the ICU, it is necessary to watch for the appearance of any clinical sign among those individuals so that a diagnosis can be made and early treatment given."

Call for Reports

The MoH asks that any case of severe iGAS infection (in other words, one that requires hospitalization) be reported to the Regional Health Agency and that iGAS strains and swabs that have tested positive for iGAS infection be routinely sent to the NRC-Strep.

This article was translated from the Medscape French edition.

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