Letter to the Editor
Comments to the article “Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence”
Comentarios sobre el artículo “Infecciones por Streptococcus pyogenes en niños españoles antes y después de la pandemia. Volviendo a la incidencia previa”
María de Ceano-Vivasa,1,
, Miguel Ángel Molina Gutiérreza,1, Rosario López Lópeza, Cristina Calvob,c,d,e
Corresponding author
a Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain
b Pediatric Infectious Diseases Department, La Paz University Hospital, Spain
c Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
d Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
e CIBER de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
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Coming back to the previous incidence”" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "114" "paginaFinal" => "115" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María de Ceano-Vivas, Miguel Ángel Molina Gutiérrez, Rosario López López, Cristina Calvo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "María" "apellidos" => "de Ceano-Vivas" "email" => array:1 [ 0 => "maria.dceano@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Miguel Ángel" "apellidos" => "Molina Gutiérrez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn1" ] ] ] 2 => array:3 [ "nombre" => "Rosario" "apellidos" => "López López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Cristina" "apellidos" => "Calvo" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Pediatric Infectious Diseases Department, La Paz University Hospital, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CIBER de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentarios sobre el artículo “Infecciones por <span class="elsevierStyleItalic">Streptococcus pyogenes</span> en niños españoles antes y después de la pandemia. Volviendo a la incidencia previa”" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2206 "Ancho" => 2508 "Tamanyo" => 343841 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Incidence of invasive GAS infections during the study period. (B) Incidence of non-invasive GAS infections during the study period. GAS: Group A Streptococcus; ED: emergency department.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">As a follow-up to the article published in your journal entitled “<span class="elsevierStyleItalic">Streptococcus pyogenes</span> infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence”,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> we would like to add some comments regarding Group A Streptococcus (GAS) infections incidence during the first semester of 2023.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our series, mild GAS infections (tonsillopharyngitis and scarlet fever) and invasive GAS infections (iGAS) decreased significantly during the pandemic period. Throughout 2022 we observed a reemergence of GAS infections reaching the pre-pandemic levels, but not higher<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> than described in the United Kingdom alert published in December 2022<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> and confirmed in other countries.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Considering that we may have identified the beginning of the outbreak, we completed the study during the first half of 2023.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Between January and June 2023, our emergency department (ED) attended 625 patients with confirmed GAS infection, 609 mild infections and 16 iGAS infections. The median age of the patients was 6.3 years (RIC: 4.2–8.5); 33.3% were aged 0–4 years, being this age distribution similar to that found in 2019. Fifty-six percent were male (350/625).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The incidence of GAS infections during the first semester 2023 was 22.9/1000 ED visits, reaching double that observed in 2022 (10.2/1000 ED visits) and 2019 (12.4/1000 ED visits) respectively. The incidence of iGAS infections also increased during these first months of 2023 (0.6/1000 ED visits), reaching nearly three times the incidence observed in 2022 (0.2/1000 ED visits) and one and a half times that of 2019 (0.4/1000 ED visits) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). These findings are like those published in Europe during the last months of 2022.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4–6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The most frequent invasive disease during the first 6 months of 2023 was mastoiditis (7/16 iGAS; 43.8%) of which 4 had local complications, while in 2022 mastoiditis accounted for 18.2% (2/11) of the iGAS. The remaining invasive diseases were 3 pneumonias, 2 meningitis, one sepsis, one epidural abscess, one orbital cellulitis complicated with subperiosteal abscess, and one peritonsillar abscess.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although we have not serotyped our GAS strains, the study cited here describes a continuous increase in emm type 1 cases throughout 2022, with a peak occurring during the latter part of the year, being the months with the highest number of cases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Furthermore, another study focusing on adults with severe pulmonary GAS infections in Scotland observed a significant predominance of the M1<span class="elsevierStyleInf">UK</span> strain during the ongoing outbreak.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In our series there were no varicella cases prior to iGAS infections as described by other authors,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5,6</span></a> but 5 of the 16 patients with invasive infection were associated with co-infection with other respiratory viruses: two influenza, two SARS-CoV-2 and one respiratory syncytial virus. Viral infections may have amplified the resurgence of iGAS infections during these months.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> In our series, we did not have any deaths.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In summary, in our series including the first semester of 2023 as in other countries, GAS infections decreased markedly during the COVID-19 pandemic, but in the post-pandemic period there has been a considerable increase in both mild and severe cases, reaching figures similar to those detected in other European countries. This delay in the increase of streptococcal infections in our region has had a parallel course to influenza infections in Spain during winter 2022–2023.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Maintain a close surveillance of <span class="elsevierStyleItalic">S. pyogenes</span> infections in the coming months and years will be relevant to know the trend and risk factors of these infections, especially invasive ones.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial disclosure</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no financial relationships relevant to this article to disclose.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial disclosure" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These authors contributed equally.</p>" "identificador" => "fn1" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2206 "Ancho" => 2508 "Tamanyo" => 343841 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Incidence of invasive GAS infections during the study period. (B) Incidence of non-invasive GAS infections during the study period. GAS: Group A Streptococcus; ED: emergency department.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Streptococcus pyogenes</span> infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. De Ceano-Vivas" 1 => "M.Á. Molina Gutiérrez" 2 => "I. Mellado-Sola" 3 => "P. García Sánchez" 4 => "D. Grandioso" 5 => "C. Calvo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimce.2023.04.021" "Revista" => array:2 [ "tituloSerie" => "Enferm Infecc Microbiol Clin (Engl Ed)" "fecha" => "2023" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "UK Health Security Agency. UKHSA update on scarlet fever and invasive group A strep. Latest data from the UK Health Security Agency (UKHSA) on scarlet fever and invasive group A strep cases. 2 December 2022. 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Gerver" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2807/1560-7917.ES.2023.28.1.2200942" "Revista" => array:5 [ "tituloSerie" => "Euro Surveill" "fecha" => "2023" "volumen" => "28" "paginaInicial" => "2200942" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36695450" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase of severe pulmonary infections in adults caused by M1<span class="elsevierStyleInf">UK</span><span class="elsevierStyleItalic">Streptococcus pyogenes</span>, Central Scotland, UK" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J.B. Davies" 1 => "C.D. Russell" 2 => "A.R. Morgan" 3 => "S.K. Taori" 4 => "D. Lindsay" 5 => "R. Ure" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3201/eid2908.230569" "Revista" => array:6 [ "tituloSerie" => "Emerg Infect Dis" "fecha" => "2023" "volumen" => "29" "paginaInicial" => "1638" "paginaFinal" => "1642" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37343545" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000004200000002/v1_202402041358/S0213005X23001878/v1_202402041358/en/main.assets" "Apartado" => array:4 [ "identificador" => "8589" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas al Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000004200000002/v1_202402041358/S0213005X23001878/v1_202402041358/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23001878?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2024 October | 35 | 10 | 45 |
| 2024 September | 47 | 3 | 50 |
| 2024 August | 48 | 5 | 53 |
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| 2024 February | 195 | 14 | 209 |
| 2024 January | 2558 | 2 | 2560 |
| 2023 December | 23 | 0 | 23 |
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| 2023 October | 50 | 3 | 53 |
| 2023 September | 17 | 7 | 24 |
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