Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group

Pediatrics. 2000 May;105(5):E60. doi: 10.1542/peds.105.5.e60.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Age Distribution
  • Chickenpox / complications*
  • Chickenpox / epidemiology
  • Child
  • Child, Preschool
  • Comorbidity
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Ontario / epidemiology
  • Poisson Distribution
  • Population Surveillance
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Streptococcal Infections / complications*
  • Streptococcal Infections / epidemiology*
  • Streptococcal Infections / microbiology
  • Streptococcus pyogenes* / classification