{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:10:56Z","timestamp":1791267056909,"version":"4.1.0"},"reference-count":47,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,5,1]]},"abstract":"<jats:sec><jats:title>Objectives.<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>During 1992\u20131996, 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>There were 1.9 cases of invasive GAS disease per 100\u2009000 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\u2009000 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\u201345). 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\u201385). Children with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95% CI: 1.8\u201322.3).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.105.5.e60","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:50:41Z","timestamp":1092441041000},"page":"e60-e60","source":"Crossref","is-referenced-by-count":219,"title":["Invasive Group A Streptococcal Disease in Children and Association With Varicella-Zoster Virus Infection"],"prefix":"10.1542","volume":"105","author":[{"given":"Kevin B.","family":"Laupland","sequence":"first","affiliation":[{"name":"Microbiology and Infectious Diseases,"},{"name":"Department of Medicine,"},{"name":"University of Calgary, Calgary, Alberta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. Dele","family":"Davies","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics and"},{"name":"Microbiology and Infectious Diseases,"},{"name":"Alberta Children's Hospital,"},{"name":"Department of Medicine,"},{"name":"University of Calgary, Calgary, Alberta;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald E.","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Mount Sinai Hospital and the Toronto Medical Laboratories, University of Toronto, Toronto, Ontario."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Childhood and Vaccine Preventable Diseases Epidemiology Section, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Mount Sinai Hospital and the Toronto Medical Laboratories, University of Toronto, Toronto, Ontario."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Ontario Group A Streptococcal Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"McGeer","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Mount Sinai Hospital and the Toronto Medical Laboratories, University of Toronto, Toronto, Ontario."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2000,5,1]]},"reference":[{"key":"2021121009372034800_B1","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1093\/clind\/16.6.792","article-title":"Severe invasive group A streptococcal infections in 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