4 Nations rapid review of iGAS deaths in children
Authors: Public Health Wales (Communicable Disease Surveillance Centre & Child Death Review Programme), UK Health Security Agency, National Child Mortality Database England, Public Health Scotland (Respiratory Bacterial Pathogens Team), National Hub for Reviewing and Learning from the Deaths of Children and Young People (Healthcare Improvement Scotland / Care Inspectorate), Public Health Agency, Northern Ireland (Health Protection Surveillance & Child Death Review Programme)
Published on: 1st March 2024
- All Wales/National
An increase in child deaths from invasive Group A Streptococcus (iGAS) was observed in the UK in the 2022/3 season, which runs from week 37 to week 36 each year (mid-September to mid-September). This coincided with higher notifications of iGAS and scarlet fever, and also Group A Streptococcus (GAS) from upper respiratory tract samples in Scotland, where scarlet fever is not notifiable, as a proxy. Whilst an increase in cases was seen in all ages, the highest percentage increase was in under 15-year-olds. A UK national incident management team (IMT) was set up with aims that included minimising the impact of iGAS infection on the paediatric UK population and providing intelligence related to changes in scarlet fever and iGAS incidence.
Previous evidence has identified that deaths from iGAS infection are most likely to occur close in time to diagnosis, 1,2 a pattern observed in the 2022/23 season. It is important to understand these trends and identify opportunities to facilitate early identification, responsive assessment, and treatment. Best practice guidance emphasises the importance of early transfer to hospital.
Alongside quantitative description and analysis of deaths from iGAS infection, a more detailed case review of deaths in children may identify patterns and themes which could inform prevention. More specifically, in reviewing out of hospital deaths to provide important insights and information leading to actions which could be taken in a community setting. Given the small numbers of deaths in children, relative to the number of cases overall, a UK-wide approach was used to increase the likelihood of being able to identify themes.
A collaborative approach between public health and Child Death Review (CDR) teams across each of
the four nations facilitated a rapid review of community deaths relating to iGAS infection, with the aim of identifying key themes, patterns and mitigations which may ultimately lead to a reduction in child deaths due to iGAS infection.
The intended audience of the report includes those involved in planning, financing and delivery of child health services.
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4 Nations rapid review of iGAS deaths in children
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