scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) annual report 2016: Prospective hospital-based surveillance for serious paediatric conditions

2019 ◽  
Vol 43 ◽  
Author(s):  
Jocelynne.E McRae ◽  
Helen.E Quinn ◽  
Gemma.L Saravanos ◽  
Alissa McMinn ◽  
Philip N Britton ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Herpes Zoster ◽  
Disease Surveillance ◽  
Acute Flaccid Paralysis ◽  
Group A Streptococcus ◽  
Invasive Group ◽  
Varicella Zoster ◽  
Vaccine Preventable Diseases ◽  
Group A

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). PAEDS data is used to better understand these conditions, inform policy and practice under the National Immunisation Program, and enable rapid public health responses for certain conditions of public health importance. PAEDS enhances data available from other Australian surveillance systems by providing prospective, detailed clinical and laboratory information on children with selected conditions. This is the third annual PAEDS report, and presents surveillance data for 2016. Methods Specialist nurses screened hospital admissions, emergency department records, laboratory and other data, on a daily basis in 5 paediatric tertiary referral hospitals in New South Wales, Victoria, South Australia, Western Australia and Queensland to identify children with the conditions under surveillance. Retrospective data on some conditions was also captured by an additional hospital in the Northern Territory. Standardised protocols and case definitions were used across all sites. Conditions under surveillance in 2016 included acute flaccid paralysis (AFP) (a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases. Most protocols restrict eligibility to hospitalisations; Emergency Department (ED) only presentations are also included for some conditions. Results In 2016, there were 673 cases identified across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach World Health Organization (WHO) reporting targets; identification of the leading infectious causes of acute encephalitis which included human parechovirus, influenza, enteroviruses, Mycoplasma pneumoniae, and bacterial meningo-encephalitis; demonstration of high influenza activity with vaccine effectiveness (VE) analysis demonstrating some protection offered through vaccination. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers increased from previous years associated with suboptimal vaccination in up to 40% of cases identified. Pertussis surveillance continued in 2016 with the addition of test negative controls captured for estimating vaccine effectiveness. Surveillance for invasive meningococcal disease showed predominance for serotype B in absence of immunisation, and new invasive group A streptococcus surveillance captured severe disease in children.   Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance. Keywords: paediatric, surveillance, child, hospital, vaccine preventable diseases, adverse event following immunisation, acute flaccid paralysis, encephalitis, influenza, intussusception, pertussis, varicella zoster virus, meningococcal, group A streptococcus.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) 2017 and 2018: Prospective hospital-based surveillance for serious paediatric conditions

2020 ◽  
Vol 44 ◽  
Author(s):  
Jocelynne E McRae ◽  
Helen E Quinn ◽  
Gemma L Saravanos ◽  
Samantha J Carlson ◽  
Philip N Britton ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Disease Surveillance ◽  
Hospital Admissions ◽  
Group A Streptococcus ◽  
Parental Attitudes ◽  
Vaccine Uptake ◽  
World Health ◽  
Invasive Group ◽  
Rotavirus Vaccines ◽  
Group A

Introduction The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine-preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2017 and 2018. Methods Specialist nurses screened hospital admissions, emergency department (ED) records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia to identify children with the conditions under surveillance. In 2017 and 2018 these included acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal, and invasive Group A streptococcus diseases. An additional social research component was added to evaluate parental attitudes to vaccination. Results PAEDS captured 1,580 and 925 cases for 2017 and 2018, respectively, across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets; identification of a third human parechovirus outbreak among other infectious diseases linked to ACE; demonstration of variable influenza activity between 2017 and 2018, with vaccine effectiveness (VE) analysis demonstrating that the protection offered through vaccination is season-dependent. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers remained unchanged, with vaccine uptake found to be suboptimal among eligible children under the NIP. Enhanced pertussis surveillance continues to capture controls for VE estimation. Surveillance for invasive meningococcal disease showed predominance for serotype B at 57% over 2 years among 77 cases where serotyping was available, and surveillance for invasive group A streptococcus captured severe disease in children. Conclusions PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance.

scholarly journals Paediatric Active Enhanced Disease Surveillance (PAEDS) 2019: Prospective hospital-based surveillance for serious paediatric conditions

2021 ◽  
Vol 45 ◽  
Author(s):  
Nicole Dinsmore ◽  
Jocelynne E McRae ◽  
Helen E Quinn ◽  
Catherine Glover ◽  
Sonia Dougherty ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Influenza Vaccination ◽  
Disease Surveillance ◽  
Group A Streptococcus ◽  
Parental Attitudes ◽  
Bloodstream Infections ◽  
World Health ◽  
Invasive Group ◽  
Gram Negative ◽  
Group A

Introduction: The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is an Australian hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2019. Methods: Specialist nurses screened hospital admissions, emergency department records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia, to identify children with the conditions under surveillance. Standardised protocols and case definitions were used across all sites. In 2019, the conditions under surveillance comprised: acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal and invasive Group A streptococcus diseases and two new conditions, Kawasaki disease and gram-negative bloodstream infections. An additional social research component continued to evaluate parental attitudes to influenza vaccination. Results: PAEDS captured 2,701 cases for 2019 across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets for detection of poliomyelitis cases; demonstration of high influenza activity in 2019 and influenza-associated deaths in ACE cases; identification of key barriers to influenza vaccination of children hospitalised for acute respiratory illness; reporting of all IS cases associated with vaccine receipt to relevant state health department; and showing a further reduction nationally in varicella cases. Enhanced pertussis surveillance continued to capture controls to support vaccine efficacy estimation. Invasive meningococcal disease surveillance showed predominance of serotype B and a reduction in cases nationally. Surveillance for invasive group A streptococcus captured severe cases in children. Monitoring of Kawasaki disease incidence and gram-negative bloodstream infections commenced. Conclusions: PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using sentinel hospital-based enhanced surveillance.

scholarly journals Cluster detection with random neighbourhood covering: application to invasive Group A Streptococcal disease.

2021 ◽  
Author(s):  
Massimo Cavallaro ◽  
Juliana Coelho ◽  
Derren Ready ◽  
Valerie Decraene ◽  
Theresa Lamagni ◽  
...  
Keyword(s):  
Public Health ◽  
Group A Streptococcus ◽  
Geographical Information ◽  
Effective Control ◽  
Invasive Group ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Group A ◽  
Sporadic Cases ◽  
Spatio Temporal

The rapid detection of outbreaks is a key step in the effective control and containment of infectious diseases. The identification of cases which might be epidemiologically linked is crucial in directing outbreak-containment efforts shaping the intervention of public health authorities. Often this requires the detection of clusters of cases whose numbers exceed those expected by a background of sporadic cases. Quantifying exceedances rapidly is particularly challenging when only few cases are typically reported in a precise location and time. To address such important public health concerns, we present a general method which can detect spatio-temporal deviations from a Poisson point process and estimate the odd of an isolate being part of a cluster. This method can be applied to diseases where detailed geographical information is available. In addition, we propose an approach to explicitly take account of delays in microbial typing. As a case study, we considered invasive group A Streptococcus infection events as recorded and typed by Public Health England from 2015 to 2020.

scholarly journals Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jane Oliver ◽  
◽  
Elise Thielemans ◽  
Alissa McMinn ◽  
Ciara Baker ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Incidence Rates ◽  
Surveillance Systems ◽  
Invasive Group ◽  
Australian State ◽  
Life Threatening ◽  
Group A

Abstract Objectives Invasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children. Methods IGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated. Results A total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12. Conclusions Robust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

A Cluster of Pediatric Invasive Group A Streptococcus Disease in Melbourne, Australia, Coinciding with a High-Burden Influenza Season

2019 ◽  
Vol 14 (04) ◽  
pp. 213-218 ◽  
Author(s):  
Nicole X. Wong ◽  
Nigel W. Crawford ◽  
Jane Oliver ◽  
Alissa McMinn ◽  
Natasha S. Ching ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Group A Streptococcus ◽  
Disease Incidence ◽  
Surveillance Network ◽  
Invasive Group ◽  
Respiratory Tract Illnesses ◽  
Group A ◽  
Viral Testing ◽  
Influenza Illness ◽  
Prospective Monitoring

Background Invasive group A streptococcal disease (IGAS) carries significant morbidity and mortality in children. Fluctuations in disease incidence are well documented. However, the modulating factors that contribute to these changes remain unclear. Prospective monitoring of IGAS cases in Victoria, Australia, showed an increased number of cases in 2017, coinciding with a peak of influenza illness. Methods Children identified to have IGAS are prospectively monitored in Melbourne through a disease surveillance network. Data on their presentation, investigations, and clinical course are collected. An increased number of cases identified between June 1, 2017, and October 31, 2017, have been retrospectively analyzed. Results We identified 22 cases of pediatric IGAS during the study period. Increased case detection occurred during a period of increased influenza disease. Of 11 children in our cohort who underwent respiratory viral testing, 4 were confirmed to have concurrent respiratory tract illnesses, and 2 were confirmed to have influenza.

scholarly journals P033: Clinical and laboratory characteristics of patients presenting to a tertiary care centre emergency department with invasive Group A Streptococcus infections

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S74-S75
Author(s):  
K. Dudar ◽  
S. Littlefield ◽  
M. Garnett
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Emergency Department ◽  
Group A Streptococcus ◽  
Vital Signs ◽  
National Average ◽  
Risk Indicator ◽  
Invasive Group ◽  
Laboratory Values ◽  
Group A

Introduction: According to the Public Health Agency of Canada, the rate of invasive Group A Streptococcus (iGAS) has more than doubled since it first became a notifiable disease in 2000. Our objectives were to describe the clinical and laboratory characteristics of iGAS in a geographic area that sees a relatively high volume of cases annually. Methods: We conducted a retrospective chart review of all adult and pediatric patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department from January 2016 to December 2017 with a hospital discharge diagnosis of iGAS infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were analyzed using univariate and bivariate statistics. Results: Forty-five cases of iGAS were identified over 2 years, with a mean age of 45 years (SD 18). The most prevalent associations were male sex (69%), diabetes mellitus (44%), current or previous alcohol abuse (38%), and current or previous intravenous drug use (33%). Prevalence of iGAS was roughly two times the national average in 2016 (11.5 per 100,000) and four times the national average in 2017 (25.5 per 100,000). Mean triage vital signs included a systolic blood pressure of 126 mmHg (SD 24), diastolic blood pressure of 73 mmHg (SD 16), temperature of 37.3°C (SD 1.4), oxygen saturation of 97% (SD 2), heart rate of 113 beats per minute (SD 22), and respiratory rate of 22 breaths per minute (SD 7). Mean laboratory values revealed a white blood cell count of 17,500 cells/μL (SD 9,800) and C-reactive protein of 243 mg/L (SD 144). A higher Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was positively correlated with longer hospital length of stay (r = 0.46, p &lt; 0.01). Conclusion: Despite its morbidity and mortality, iGAS infections often present insidiously with only mild abnormalities in triage vital signs, and require a high index of suspicion by the emergency physician for a prompt diagnosis, particularly in at-risk populations such as patients with diabetes mellitus or those who misuse alcohol or drugs.

Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection

2020 ◽  
Vol 13 (12) ◽  
pp. e236800
Author(s):  
Grace Anne McCabe ◽  
Thomas Hardy ◽  
Thomas Gordon Campbell
Keyword(s):  
Group A Streptococcus ◽  
Early Recognition ◽  
Skin Grafting ◽  
Final Diagnosis ◽  
Necrotising Fasciitis ◽  
Invasive Group ◽  
Group A ◽  
Tissue Microscopy ◽  
Periorbital Swelling ◽  
Multidisciplinary Teamwork

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.

Group A β-Hemolytic Streptococcal Bacteremia: Historical Overview, Changing Incidence, and Recent Association With Varicella

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 428-433
Author(s):  
Allan Doctor ◽  
Marvin B. Harper ◽  
Gary R. Fleisher
Keyword(s):  
Retrospective Chart Review ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Invasive Group ◽  
Exact Test ◽  
Physician Visits ◽  
Varicella Zoster ◽  
Group A ◽  
Occult Bacteremia ◽  
Bacterial Superinfection

Objective. To quantitate the increase in invasive group A β-hemolytic streptococcal (GABHS) infections and to define a possible association between GABHS bacteremia and primary varicella zoster virus (VZV) infections. Methods. This was a retrospective chart review conducted at Children's Hospital. Participants were patients with documented GABHS bacteremia occurring from January 1977 through December 1993. Measurements/Main Results. We identified 63 episodes of GABHS bacteremia in 62 patients. From 1977 to 1992, a mean of 3.2 ± 2 cases occurred per year (range, 0 to 6), increasing by a factor of 3 (10 cases) in 1993. The median age was 4 years (range, 1 day to 20 years; mean, 8 years ± 3 months); 36 were male; five children were immunocompromised. One child was dead on arrival and one had a cardiac arrest during evaluation in the emergency department. Primary sites of infection (oropharynx, skin, or middle ear) were identified in 40 (75%) of the cases; in addition, 10 cases occurred in patients with primary VZV. From 1977 to 1992, we identified five VZV-associated cases; an average of 7 ± 11.5% of the patients with GABHS had concurrent VZV infection annually, with no more than one case per year. In 1993, 50% of the 10 new GABHS cases were in children with VZV infection (P = .003, Fisher's exact test). The diagnosis of invasive GABHS infection in patients with VZV was not readily recognized, requiring a median of two (range, one to four) physician visits before admission and the administration of antibiotics. All 10 children were diagnosed on the fourth or fifth day of the exanthem and were febrile (39.6 ± 1.1°C, range, 38.3 to 40.8°C), with a mean white blood cell count (WBC) of 11 500 ± 8 400/mm3 (8 of 10 cases had a WBC less than 15 000/mm3). None of the five VZV-associated cases in 1993 had signs of cutaneous bacterial superinfection; among these were two cases of streptococcal toxic shock syndrome (one death), one case of osteomyelitis, and two cases of occult bacteremia. Of the five VZV-associated cases before 1993, one patient was diagnosed with supraglottitis, one with septic arthritis, one with orbital cellulitis, and two solely with impetiginized or cellulitic lesions. Conclusions. We found that the incidence of invasive GABHS infections has risen dramatically, increasing by a factor of 3 over the past year. In 1993, 50% of new cases of invasive GABHS disease were associated with VZV infection. Invasive GABHS should be considered in children with VZV who manifest fever on or beyond the fourth day of the exanthem. The absence of an elevated WBC and impetiginized or cellulitic lesions should not eliminate this diagnosis from consideration.

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