title: Invasive Group A Streptococcal Infections in Children: A Nationwide Survey in Finland.
abstract: BACKGROUND
  The incidence of invasive group A streptococcus (iGAS) infections varies in time and geographically for unknown reasons. We performed a nationwide survey to assess the population-based incidence rates and outcomes of children with iGAS infections.
  
  
  METHODS
  We collected data on patients from hospital discharge registries and the electronic databases of microbiological laboratories in Finland for the period 1996-2010. We then recorded the emm types or serotypes of the strains. The study physician visited all university clinics and collected the clinical data using the same data entry sheet.
  
  
  RESULTS
  We identified 151 children with iGAS infection. Varicella preceded iGAS infection in 20% of cases and fasciitis infection in 83% of cases. The annual incidence rate of iGAS infection was 0.93 per 100,000 in 1996-2000, 1.80 in 2001-2005 and 2.50 in 2006-2010. The proportion of emm 1.0 or T1M1 strains peaked in 1996-2000 and again in 2006-2010, to 44% and 37% of all typed isolates. The main clinical diagnoses of the patients were severe soft-tissue infection (46%), sepsis (28%), empyema (10%), osteoarticular infection (9%) and primary peritonitis (5%). Severe pain was the most typical symptom for soft-tissue infections. More than half of the patients underwent surgery and received clindamycin. The readmission rate was 7%, and the case fatality rate was 2%.
  
  
  CONCLUSIONS
  The incidence rate of pediatric iGAS infections tripled during our study. The increase was not, however, the result of a change in the strain types causing iGAS. Varicella immunization would likely have prevented a significant number of the cases.
authors.affiliation: From the *Department of Pediatrics and Adolescents, Medical Research Center and PEDEGO Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland; †Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; ‡Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland; §Department of Pediatrics, Turku University Hospital, Turku, Finland; ¶Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland; ‖Bacterial Infections Unit, National Institute of Health and Welfare, Turku, Finland; **Department of Medical Microbiology and Immunology, University of Turku, Turku, Finland; and ††Department of Geography, University of Oulu, Oulu, Finland.
authors.forename: Terhi
authors.initials: T
authors.lastname: Tapiainen
authors.forename: Saana
authors.initials: S
authors.lastname: Launonen
authors.forename: Marjo
authors.initials: M
authors.lastname: Renko
authors.forename: Harri
authors.initials: H
authors.lastname: Saxen
authors.forename: Eeva
authors.initials: E
authors.lastname: Salo
authors.forename: Matti
authors.initials: M
authors.lastname: Korppi
authors.forename: Leena
authors.initials: L
authors.lastname: Kainulainen
authors.forename: Tarja
authors.initials: T
authors.lastname: Heiskanen-Kosma
authors.forename: Laura
authors.initials: L
authors.lastname: Lindholm
authors.forename: Jaana
authors.initials: J
authors.lastname: Vuopio
authors.forename: Tiina
authors.initials: T
authors.lastname: Huotari
authors.forename: Jarmo
authors.initials: J
authors.lastname: Rusanen
authors.forename: Matti
authors.initials: M
authors.lastname: Uhari
mesh_terms: D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D065288:Serogroup; D012703:Serotyping; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; C014689:streptococcal M protein