Invasive group a streptococcal disease in children and association with varicella-zoster virus infection
Invasive group a streptococcal disease in children and association with varicella-zoster virus infection
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DOI：
10.1542/peds.105.5.e60
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发表时间：
2000-05-01
期刊：
影响因子：
8
通讯作者：
McGeer, A
中科院分区：
文献类型：
--
作者：
Laupland, KB;Davies, HD;McGeer, A
目标.描述安大略儿童侵袭性A组链球菌（GAS）疾病的发病率和临床特征，并确定水痘后侵袭性GAS感染的风险。在1992-1996年期间，我们对加拿大安大略（人口：1100万; 250万儿童）的儿童侵袭性GAS疾病进行了前瞻性、主动性、基于人群的监测，并回顾了临床和实验室记录。每年每10万名儿童中有1.9例侵袭性GAS疾病。链球菌中毒性休克综合征（STSS）发生率为7%，坏死性筋膜炎（NF）发生率为4%，每年的发病率分别为0.08/10万和0.13/10万。STSS的病死率为56%，NF为10%，总体为4%。除哮喘外，慢性基础疾病的存在与死亡相关（相对危险度[RR]：11; 95%置信区间[CI]：2.4-45）。确定的儿童中有15%先前有水痘感染，这显著增加了获得侵袭性GAS疾病的风险（RR：58; 95% CI：40-85）。侵袭性GAS和近期水痘的儿童更可能患有NF（RR：6.3; 95%CI：1.8-22.3）。儿童侵袭性GAS疾病的发生率与成人人群相似，但STSS和病死率较低。水痘大大增加了获得侵袭性GAS疾病的风险，通用水痘疫苗接种可能预防高达15%的所有儿科侵袭性GAS疾病。
Objectives. To describe the incidence and clinical features of invasive group A streptococcal (GAS) disease in children in Ontario and determine the risk of invasive GAS infection following chickenpox.Methods. During 1992-1996, we conducted prospective, active, population-based surveillance for pediatric invasive GAS disease in Ontario, Canada (population: 11 million; 2.5 million children) and reviewed clinical and laboratory records.Results. There were 1.9 cases of invasive GAS disease per 100 000 children per year. Streptococcal toxic shock syndrome (STSS) occurred in 7% of cases and necrotizing fasciitis (NF) in 4% for incidences of .08 and .13 per 100 000 per year, respectively. Case-fatality rates were 56% for STSS, 10% for NF, and 4% overall. The presence of chronic underlying illness other than asthma was associated with death (relative risk [RR]: 11; 95% confidence interval [CI]: 2.4-45). Fifteen percent of children identified had preceding chickenpox infection, which significantly increased the risk for acquisition of invasive GAS disease (RR: 58; 95% CI: 40-85). Children with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95% CI: 1.8-22.3).Conclusions. Childhood invasive GAS disease occurs at an incidence similar to the adult population but has a lower rate of STSS and case-fatality. Chickenpox dramatically increases the risk for acquiring invasive GAS disease, and universal chickenpox vaccination could potentially prevent up to 15% of all pediatric invasive GAS disease.