{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T17:51:35Z","timestamp":1784569895742,"version":"3.55.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In the fall of 2022, we observed a sharp rise in pediatric Invasive Group A Streptococcus (iGAS) hospitalizations in Colorado. We compared the epidemiology, clinical features, and patient outcomes in this outbreak to prior years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Between October 2022 and April 2023, we prospectively identified and reviewed iGAS cases in hospitalized pediatric patients at Children\u2019s Hospital Colorado. Using laboratory specimen records, we also retrospectively compared the number of patients with sterile site GAS-positive cultures across three time periods: pre-COVID-19 (January 2015\u2013March 2020), height of COVID-19 pandemic (April 2020\u2013September 2022), and outbreak (October 2022\u2013April 2023).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 96 prospectively identified iGAS cases, median age was 5.7 years old; 66% were male, 70% previously healthy, 39% required critical care, and four patients died. Almost 60% had associated respiratory viral symptoms, 10% had toxic shock syndrome, and 4% had necrotizing fasciitis. Leukopenia, bandemia, and higher C-reactive protein values were laboratory findings associated with need for critical care. There were significantly more cases during the outbreak (9.9\/month outbreak vs 3.9\/month pre-pandemic vs 1.3\/month pandemic), including more cases with pneumonia (28% outbreak vs 15% pre-pandemic vs 0% pandemic) and multifocal disease (17% outbreak vs 3% pre-pandemic vs 0% pandemic), P\u2005&amp;lt;\u2005.001 for all.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Outbreak case numbers were almost triple the pre-pandemic baseline. The high percentage of cases with associated viral symptoms suggests a link to coinciding surges in respiratory viruses during this time. Invasive GAS can be severe and evolve rapidly; clinical and laboratory features may help in earlier identification of critically ill children.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piad080","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T18:13:57Z","timestamp":1696443237000},"page":"540-548","source":"Crossref","is-referenced-by-count":21,"title":["Outbreak of Invasive Group A <i>Streptococcus<\/i> in Children\u2014Colorado, October 2022\u2013April 2023"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7425-5466","authenticated-orcid":false,"given":"Erin C","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"},{"name":"Section of Infectious Diseases, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-0304","authenticated-orcid":false,"given":"Jessica R","family":"Cataldi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"},{"name":"Section of Infectious Diseases, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori J","family":"Silveira","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Birkholz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele M","family":"Loi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"},{"name":"Section of Critical Care Medicine, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M","family":"Osborne","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, Children\u2019s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA and"},{"name":"Department of Pediatrics, Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia , Philadelphia, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel R","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"},{"name":"Section of Infectious Diseases, University of Colorado School of Medicine and Children\u2019s Hospital Colorado , Aurora, Colorado , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"2023102813591912300_CIT0001","volume-title":"National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases. 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