{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:01:14Z","timestamp":1793102474179,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n The upsurge in invasive disease caused by\n Streptococcus pyogenes<\/jats:italic>\n among children reported in several European countries during 2022 to 2023 has not been fully explained.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To evaluate whether changes in the circulation of common respiratory pathogens associated with the introduction of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic were associated with acquisition of immunity to\n S pyogenes<\/jats:italic>\n and common respiratory viruses.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study recruited children with suspected infection and afebrile control participants at hospitals in 10 European countries. Data were collected before (September 2016 to March 2020) and after (April 2020 to July 2023) the introduction of NPIs.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n Molecular detection of bacterial and viral pathogens on throat swabs and age-stratified total serum immunoglobin G (IgG) reactivity to\n S pyogenes<\/jats:italic>\n cell wall extract from 2 strains, respiratory syncytial virus (RSV), 5 influenza viruses, 4 common cold coronaviruses, and SARS-CoV-2, measured by immunoassay.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Throat swabs from 1942 children aged 0 to 4 years were tested for respiratory pathogens (1449 recruited before introduction of NPIs [median (IQR) age, 19.7 (8.2-38.1) months; 798 (55.1%) male]; 493 recruited after [median (IQR) age, 20.7 (9.7-38.1) months; 269 (54.7%) male]). A decrease in detection of\n S pyogenes,<\/jats:italic>\n RSV, common cold coronaviruses, and influenza viruses was observed between March 2020 to July 2021, corresponding to the maximal period of NPIs. Antibodies to\n S pyogenes<\/jats:italic>\n were measured in 252 children recruited before NPIs and 200 thereafter. Antibodies to viral antigens were measured in 230 children before NPIs and 92 thereafter. Total IgG to\n S pyogenes<\/jats:italic>\n and RSV was significantly lower in children aged 3 to 4 years recruited after NPI introduction compared with those recruited before (\n S pyogenes emm1<\/jats:italic>\n strain: after, 67 participants; median [IQR] 0.13 [0.44-0.44] relative units [RU]; before, 87 participants; median [IQR] 0.35 [0.10-0.65] RU;\n P<\/jats:italic>\n \u2009=\u2009.007. RSV: after, 30 participants; median [IQR] 49.6 [31.1-120.7] mesoscale units [MU]\/1000; before, 76 participants; median [IQR] 141.8 [78.1-423.1] MU\/1000;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). No such differences were observed for children aged 0 to 2 years or for individual influenza viruses or SARS-CoV-2.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this cross-sectional study, there was a significant reduction in serum antibodies to\n S pyogenes<\/jats:italic>\n and RSV in children aged 3 to 4 years after introduction of NPIs. Equivalent to approximately a 1-year delay in acquisition of immunity, these data suggest a putative biological basis for the 2022 to 2023 upsurge in severe\n S pyogenes<\/jats:italic>\n infections in this age group.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.37808","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T13:00:23Z","timestamp":1764680423000},"page":"e2537808","source":"Crossref","is-referenced-by-count":15,"title":["Immunity to\n Streptococcus pyogenes<\/i>\n and Common Respiratory Viruses at Age 0 to 4 Years After COVID-19 Restrictions"],"prefix":"10.1001","volume":"8","author":[{"given":"Kitt","family":"Dokal","sequence":"first","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Channon-Wells","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"},{"name":"UKRI Centre for Doctoral Training in AI for Healthcare, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Davis","sequence":"additional","affiliation":[{"name":"Micropathology Ltd, University of Warwick, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Estrada-Rivadeneyra","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin K.","family":"Huse","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Bacterial Resistance Biology, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Lias","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Bacterial Resistance Biology, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shea","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca L.","family":"Guy","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance & Healthcare-Associated Infection Division, UK Health Security Agency, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Lamagni","sequence":"additional","affiliation":[{"name":"Antimicrobial Resistance & Healthcare-Associated Infection Division, UK Health Security Agency, London, United Kingdom"},{"name":"NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London and UK Health Security Agency, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Taylor","sequence":"additional","affiliation":[{"name":"Micropathology Ltd, University of Warwick, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp K. A.","family":"Agyeman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amutha","family":"Anpananthar","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Basmaci","sequence":"additional","affiliation":[{"name":"Service de P\u00e9diatrie-Urgences, AP-HP, H\u00f4pital Louis-Mourier, Colombes, France"},{"name":"Universit\u00e9 Paris Cit\u00e9, INSERM, IAME, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enitan D.","family":"Carrol","sequence":"additional","affiliation":[{"name":"Department of Clinical Infection, Microbiology and Immunology, Veterinary and Ecological Sciences, University of Liverpool Institute of Infection, Liverpool, United Kingdom"},{"name":"Department of Infectious Diseases, Alder Hey Children\u2019s Hospital, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Carter","sequence":"additional","affiliation":[{"name":"Evelina London Children\u2019s Hospital, Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tisham","family":"De","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marien I.","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Immunology, Radboud Institute for Medical Innovation, Radboud UMC, Nijmegen, the Netherlands"},{"name":"Radboud Community for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Emonts","sequence":"additional","affiliation":[{"name":"Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom"},{"name":"Great North Children\u2019s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom"},{"name":"NIHR Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leire Estramiana","family":"Elorrieta","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Imperial College London, London, United Kingdom"},{"name":"Centre for Paediatrics and Child Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katy","family":"Fidler","sequence":"additional","affiliation":[{"name":"Brighton and Sussex Medical School, University of Sussex, East Sussex, United Kingdom"},{"name":"Royal Alexandra Children\u2019s Hospital, Brighton, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojca","family":"Kolnik","sequence":"additional","affiliation":[{"name":"University Childrens\u2019 Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taco W.","family":"Kuijpers","sequence":"additional","affiliation":[{"name":"Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands"},{"name":"Sanquin Research Institute & Landsteiner Laboratory at the AMC, University of Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Martinon-Torres","sequence":"additional","affiliation":[{"name":"Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Cl\u00ednico Universitario de Santiago, Santiago de Compostela, Spain"},{"name":"GENVIP Research Group, Instituto de Investigaci\u00f3n Sanitaria de Santiago, Universidad de Santiago de Compostela, Galicia, Spain"},{"name":"CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henriette","family":"Moll","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics, Erasmus MC\u2013Sophia Children\u2019s Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Mommert-Tripon","sequence":"additional","affiliation":[{"name":"Innovation & Partnerships, bioM\u00e9rieux, Marcy l\u2019Etoile, France"},{"name":"Joint Research Unit Hospice Civils de Lyon\u2013bioM\u00e9rieux, Centre Hospitalier Lyon Sud, Pierre-B\u00e9nite, France"},{"name":"EA 7426 Pathophysiology of Injury-Induced Immunosuppression, Lyon 1 University, Hospices Civils de Lyon\u2013bioM\u00e9rieux, H\u00f4pital Edouard Herriot, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Neshat","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Nyirenda-Nyang\u2019wa","sequence":"additional","affiliation":[{"name":"Lewisham and Greenwich NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"O\u2019Riordan","sequence":"additional","affiliation":[{"name":"Leeds Children\u2019s Hospital, Leeds, United 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Disease Unit, Academic Department of Pediatrics, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prita","family":"Rughani","sequence":"additional","affiliation":[{"name":"Barts Health NHS Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luregn J.","family":"Schlapbach","sequence":"additional","affiliation":[{"name":"Department of Intensive Care and Neonatology, University Children\u2019s Hospital Zurich, University of Zurich, Zurich, Switzerland"},{"name":"Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina A.","family":"Schweintzger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, 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Kyriakou\u201d Children\u2019s Hospital, Athina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Effua","family":"Usuf","sequence":"additional","affiliation":[{"name":"Medical Research Council Unit, The Gambia at LSHTM, Fajara, The Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel","family":"van der Flier","sequence":"additional","affiliation":[{"name":"Wilhelmina Children\u2019s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clementien","family":"Vermont","sequence":"additional","affiliation":[{"name":"Department of Paediatric Infectious Diseases & Immunology, Erasmus MC\u2013Sophia Children\u2019s Hospital, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"von Both","sequence":"additional","affiliation":[{"name":"Division of Paediatric Infectious Diseases, Hauner Children\u2019s 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