Increased Incidence and Severity of Group A Streptococcal Infections in Children in Southeast Texas from June 2022 to May 2023

Background: Group A Streptococcus (GAS) infections can cause a range of disease manifestations and severity, including invasive infections that can lead to death. In 2022-2023, there was an increased number of cases of invasive GAS in the United States following a decline in 2020-2022. Methods: We investigated this surge at a 3-hospital system of children's hospitals in Southeast Texas. Cases of invasive GAS (n = 252) were retrospectively reviewed from peak periods of infection, beginning June 2019-May 2020 and continuing each successive year until May 2023. Cases were analyzed based on patient demographics, disease manifestations, coinfections, and hospital course. Isolates grown in culture were sequenced, and the emm types and genes associated with virulence were analyzed. Results: Compared with previous years, June 2022-May 2023 had the largest number of invasive GAS cases (n = 154, 2022-2023; 34, 2021-2022; 12, 2020-2021; 52, 2019-2020). Compared with the previous 3 years, patients from 2022 to 2023 were more likely to present with complicated pneumonia (23.4% vs. 7.1%; P = 0.0009), require respiratory support (34.4% vs. 14.3%; P < 0.001), be admitted to the intensive care unit (29.2% vs. 16.3; P = 0.0235), and be infected with emm type 12 isolates (40.6% vs. 10.3%; P = 0.0030). Conclusions: In June 2022-May 2023, there was a 5-fold surge of invasive GAS infection cases in children at Texas Children's Hospital compared with the previous 3 years. These cases required greater intensive care unit hospitalization and respiratory support requirements due to higher rates of complicated pneumonia.