20.500.12556/DiRROS-24687 Paediatric invasive group A streptococcal infections and associations with viral infections in 15 European countries after lifting non-pharmaceutical interventions against SARS-CoV-2 an interrupted time-series analysis Background: After lifting non-pharmaceutical interventions (NPIs) against the transmission of SARS-CoV-2, various countries experienced an increase in invasive Group A Streptococcal (iGAS) infections. We aimed to characterise the paediatric outbreak across Europe and to analyse the influence of viral infections. Methods: We conducted an interrupted time-series analysis based on data from 15 European countries from the PEGASUS consortium. We assessed the evolution of the number of iGAS cases aged 1 month to 18 years between 01/01/2018 and 03/31/2024, comparing the post-NPIs period (01-04-2022 until 31-03-2024) to the baseline period (01-01-2018 until 31-03-2020). Further analyses were performed by country, clinical phenotype, age and severity, including sensitivity analyses. We then explored whether certain iGAS phenotypes correlated with trends in RSV, influenza and VZV across countries over time using Google Trends data. Findings: We included 2091 iGAS cases over the study period; 79 children (3.6%) died and 580 (27.7%) required PICU admission. We estimated an overall increase of +229.8% (95% CI (141.9-341.6)) among iGAS cases from October 2022 to March 2024, compared to the baseline period. The observed increases varied across clinical phenotypes, ranging from +62.7% (95% CI (8.3-157.9)) for osteo-articular infections to +238.7% (95% CI 75.8-464.8) for pneumonia. We observed a strong correlation between the incidence of iGAS pneumonia and RSV (Rho: 0.57, 95% CI [0.11-0.79]) and influenza (Rho 0.69, 95% CI 0.35-0.87); and between skin and soft tissue infections and VZV (Rho: 0.73, 95% CI [0.42-0.89]). Interpretation: The patterns observed across Europe during this outbreak demonstrate an association between respiratory viruses as well as VZV, and iGAS. Streptococcus pyogenes group A streptococcus invasive streptococcal disease outbreak paediatrics viral infections viruses influenza flu RSV respiratory syncytial virus VZV varicella immunity debt non pharmaceutical interventions true false true Angleški jezik Ni določen Neznano 2025-12-12 12:18:04 2025-12-12 12:18:05 2025-12-13 03:51:07 0000-00-00 00:00:00 2025 0 0 Nasl. z nasl. zaslona; Opis vira z dne 5. 11. 2025; str. 1-14 Vol. 59, [article no.] 101497 2025 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.9 2666-7762 10.1016/j.lanepe.2025.101497 255909891 RAZ_Lenglart_Lea_2025.pdf RAZ_Lenglart_Lea_2025.pdf 1 1ADBD04753ED7D3DAF5E4E44AF4A33DF 541f93329b51b6de6ee98a71ad1ccda8ec4749237762ec04fe2ca6cc8392d089 61cd2c80-d74c-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=36861 https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(25)00289-3/fulltext 0 6ee57aab-d74c-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=36862 Univerzitetni klinični center Ljubljana 0 0 0