November 29, 2023
In December 2022, the World Health Organization (WHO) warned of an increase in cases of invasive group A Streptococcus (GAS) infections in Europe, especially in children under 10 years of age. During the same period, the Pan American Health Organization (PAHO) issued an information note on reported cases of invasive GAS disease in Uruguay. In November 2023, Argentina reported a significant increase in reports of cases and deaths due to this substance, with recent reports highlighting the presence in the country of the M1UK clone and the M1 sublineage harboring the SpeC toxin as being implicated in this increase. In view of this situation, PAHO/WHO recommends that member states carry out clinical and genomic surveillance and ensure early diagnosis and prompt treatment of cases of group A streptococcal invasive disease.
WHO recommendations
The following is a summary of key recommendations for surveillance, clinical management, prevention and risk communication.
arrive.Clinical and Genomic Surveillance
• Strengthen detection, characterization and trend surveillance activities for invasive GAS infection cases.
• Report all unusual and unexpected forms of infection (invasive forms, outbreaks) caused by this pathogen to the surveillance system.
• Inform the International Health Regulations (IHR) focal point if there is an unexpected surge in the national or regional incidence of such invasive infections.
• Ensure that all strains isolated from invasive patients are sent to the National Public Health Laboratory for further characterization and genomic surveillance of lineages (clones) and sublineages.
b. Clinical management, infection prevention and control, and prophylaxis
• Health care professionals should maintain a high clinical suspicion of GAS infection, especially when evaluating patients with previous viral infection, direct exposure to scarlet fever cases, or invasive GAS infection.
• Encourage consultation for all cases with suspected symptoms of GAS and proceed with diagnosis, isolation and appropriate and timely treatment.
• If admitted to hospital with an invasive infection, precautions should be taken to avoid transmission through respiratory droplets, in addition to observing standard precautions at all times. Contact precautions are required if tissue is involved (necrotizing fasciitis, wound infection, skin injury). Respiratory and contact droplet precautions can be discontinued 24 hours after antimicrobial treatment.
• Although there are no general recommendations for prophylaxis, this measure may be considered based on the exposure and immune status of the contact. For example, prophylaxis could be considered for close family members who share a bed or have been in close contact, as well as caregivers who spend a long time with an infected person. Immunosuppressed contacts, pregnant women, people who have had recent surgery, injuries, or a family history of rheumatic fever may also be evaluated. Likewise, the drug may be considered during an outbreak of pharyngitis, acute rheumatic fever, or poststreptococcal glomerulonephritis in a closed community.
o Treatment options include penicillin (adults, 250 mg PO/6 hours for 10 days; children, 25 mg/kg – maximum 250 mg per dose – PO/6 hours for 10 days). In the case of penicillin allergy, clindamycin or azithromycin may be selected after confirming the susceptibility of the index patient isolate to these antimicrobials.
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