The association between the scarlet fever and meteorological factors, air pollutants and their interactions in children in northwest China.

Scarlet fever (SF) is an acute respiratory transmitted disease that primarily affects children. The influence of meteorological factors and air pollutants on SF in children has been proved, but the relevant evidence in Northwest China is still lacking. Based on the weekly reported cases of SF in children in Lanzhou, northwest China, from 2014 to 2018, we used geographical detectors, distributed lag nonlinear models (DLNM), and bivariate response models to explore the influence of meteorological factors and air pollutants with SF. It was found that ozone (O3), carbon monoxide (CO), sulfur dioxide (SO2), temperature, pressure, water vapor pressure and wind speed were significantly correlated with SF based on geographical detectors. With the median as reference, the influence of high temperature, low pressure and high pressure on SF has a risk effect (relative risk (RR) > 1), and under extreme conditions, the dangerous effect was still significant. High O3 had the strongest effect at a 6-week delay, with an RR of 5.43 (95%CI: 1.74,16.96). The risk effect of high SO2 was strongest in the week of exposure, and the maximum risk effect was 1.37 (95%CI: 1.08,1.73). The interactions showed synergistic effects between high temperatures and O3, high pressure and high SO2, high nitrogen dioxide (NO2) and high particulate matter with diameter of less than 10 µm (PM10), respectively. In conclusion, high temperature, pressure, high O3 and SO2 were the most important factors affecting the occurrence of SF in children, which will provide theoretical support for follow-up research and disease prevention policy formulation.

Retrospective analysis of an outbreak of scarlet fever in United Arab Emirates.

Background: Scarlet fever is an infectious disease caused by Streptococcus pyogenes. However, there is limited data regarding the disease in the Arab World, including the United Arab Emirates. Objective: To analyse a scarlet fever outbreak in United Arab Emirates. Methods: This retrospective cross-sectional study included scarlet fever cases diagnosed at the Kanad Hospital, Al Ain, United Arab Emirates in 2022 and 2023. Data were retrieved from the hospital records and analysed using SPSS version 23.0. Chi-Square, Mann-Whitney, and Monte Carlo tests were applied. Results: Two hundred and twenty-two cases (13.5% in 2022 and 86.5% in 2023) were confirmed (P<0.001). Majority (67.1%) of the patients were aged 3-6 years, with a mean age of 4.56 ± 1.99 years. Rash, fever and sore throat were observed in 100%, 99.1%, and 82.0% of cases, respectively. The majority (85.1%) were managed as outpatients and 77.0% responded to oral penicillin. Patients' age was not significantly associated with nonresponse to penicillin and in-hospital admission. The outbreak had winter and summer peaks, with the highest incidence occurring during January and February 2023. Conclusion: This study serves as a valuable reference for other studies, which should include antimicrobial susceptibility testing and the prevailing genetic variance of Streptococcus pyogenes.

Scaling features in high-concentrations PM2.5 evolution: the Ignored factor affecting scarlet fever incidence.

As an acute respiratory disease, scarlet fever has great harm to public health. Some evidence indicates that the time distribution pattern of heavy PM2.5 pollution occurrence may have an impact on health risks. This study aims to reveal the relation between scaling features in high-concentrations PM2.5 (HC-PM2.5) evolution and scarlet fever incidence (SFI). Based on the data of Hong Kong from 2012 to 2019, fractal box-counting dimension (D) is introduced to capture the scaling features of HC-PM2.5. It has been found that index D can quantify the time distribution of HC-PM2.5, and lower D values indicate more cluster distribution of HC-PM2.5. Moreover, scale-invariance in HC-PM2.5 at different time scales has been discovered, which indicates that HC-PM2.5 occurrence is not random but follows a typical power-law distribution. Next, the exposure-response relationship between SFI and scale-invariance in HC-PM2.5 is explored by Distributed lag non-linear model, in conjunction with meteorological factors. It has been discovered that scale-invariance in HC-PM2.5 has a nonlinear effect on SFI. Low and moderate D values of HC-PM2.5 are identified as risk factors for SFI at small time-scale. Moreover, relative risk shows a decreasing trend with the increase of exposure time. These results suggest that exposure to short-term clustered HC-PM2.5 makes individual more prone to SFI than exposure to long-term uniform HC-PM2.5. This means that individuals in slightly-polluted regions may face a greater risk of SFI, once the PM2.5 concentration keeps rising. In the future, it is expected that the relative risk of scarlet fever for a specific region can be estimated based on the quantitative analysis of scaling features in high-concentrations PM2.5 evolution.

Invasive Streptococcal Infection in Children: An Italian Case Series.

Since October 2022, alerts have spread from several countries about the increase in invasive group A streptococcal (iGAS) and scarlet fever cases affecting young children. We aim to analyze the epidemiology of GAS infections in the last 12 years in our hospital and identify the clinical features of invasive cases observed in 2023. We conducted a retrospective study enrolling children and adolescents hospitalized at our pediatric clinic from January to December 2023 for a definitive diagnosis of iGAS infection. Clinical, laboratory, and imaging data were collected and analyzed. Comparing 2016 and 2023, we observed a similar number of GAS infections (65 vs. 60 cases). Five children with iGAS infection were hospitalized between March and April 2023. The median age was five years. At admission, all patients showed tachycardia disproportionate to their body temperature. Vomiting was a recurrent symptom (80%). Laboratory tests mostly showed lymphopenia, hyponatremia, and high inflammatory markers. The number of pediatric iGAS cases significantly increased in 2023. Clinical (pre-school-aged children with high fever, unexplained tachycardia, and vomiting) and laboratory parameters (high procalcitonin levels, hyponatremia, and lymphopenia) could help identify and suspect a potential iGAS infection.

Infodemiology and infoveillance: framework for contagious exanthematous diseases, of childhood in Italy.

BACKGROUND: Contagious exanthematous diseases are becoming a major public health problem. The purpose of this study was to evaluate the potential epidemiological trend of four infectious exanthematous diseases in Italy through the searches on the internet. METHODS: We used the following Italian search term: 'Sesta malattia' (Sixth Disease, in English), 'Eritema Infettivo' (also knows 'Quinta malattia' in Italian; Fifth Disease in English), 'Quarta malattia' (Fourth Disease in English) and 'Scarlattina' (Scarlet fever in English). We overlapped Google Trends and Wikipedia data to perform a linear regression and correlation analysis. Statistical analyses were performed using the Spearman's rank correlation coefficient (rho). The study period is between July 2015 and December 2022. RESULTS: The diseases considered have a seasonal trend and the search peaks between GT and Wikipedia overlap. A temporal correlation was observed between GT and Wikipedia search trends. Google Trends Internet search data showed strong correlation with Wikipedia with a rho statistically significant for Fifth disease (rho = 0.78), Fourth disease (rho = 0.76) and Scarlet-fever (rho = 0.77), moderate correlation for Sixth disease (rho = 0.32). CONCLUSIONS: Infectious disease searches using Google and Wikipedia can be useful for public health surveillance and help policy makers implement prevention and information programs for the population, in addition to the fact that increases in searches could represent an early warning in the detection of outbreaks.

Detection of toxigenic M1UK lineage group A Streptococcus clones in Taiwan.

BACKGROUND: A new sublineage of emm1 group A Streptococcus (GAS), M1UK, has emerged in Europe, North America, and Australia. Notably, a significant portion of emm1 isolates in Asia, particularly in Hong Kong and mainland China, acquired scarlet fever-associated prophages following the 2011 Hong Kong scarlet fever outbreak. However, the presence of the M1UK sublineage has not yet been detected in Asia. METHODS: This study included 181 GAS isolates (2011-2021). The emm type of these isolates were determined, and 21 emm1 isolates from blood or pleural fluid (2011-2021) and 10 emm1 isolates from throat swabs (2016-2018) underwent analysis. The presence of the scarlet fever-associated prophages and the specific single nucleotide polymorphisms of the M1UK clone were determined by polymerase chain reaction and the genome sequencing. RESULTS: The M1UK lineage strains from throat swab and blood samples were identified. One of the M1UK strain in Taiwan carried the scarlet fever-associated prophage and therefore acquired the ssa, speC, and spd1 toxin repertoire. Nonetheless, the increase of M1UK was not observed until 2021, and there was a reduction in the diversity of emm types in 2020-2021, possibly due to the COVID-19 pandemic restriction policies in Taiwan. CONCLUSIONS: Our results suggested that the M1UK lineage clone has introduced in Taiwan. In Taiwan, the COVID-19 restrictions were officially released in March 2023; therefore, it would be crucial to continuously monitor the M1UK expansion and its related diseases in the post COVID-19 era.

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence.

INTRODUCTION: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018-2022 in our hospital. METHODS: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. RESULTS: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). CONCLUSIONS: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.

Medical aspects of the tour by Martin Martin (c 1660-1719) of the Western and Northern Islands of Scotland, Circa 1695.

This review is based investigations on the Western Isles, Scotland, by Martin Martin, a notable Scottish Highlander, academic and medical doctor, of the 17th-18th century. His extensive observations of the geography and peoples of these Isles were recorded in his books, "On the Description of the Western Islands of Scotland Circa 1695" and "A Late Voyage to St Kilda". In these books and subsequent papers there were some noteworthy observations on the occurrence (and as he says non-occurrence) of "epidemical" diseases and conditions afflicting the peoples of The Isle of Skye and the Western Isles of Scotland in this period, and these are discussed in this review. Martin also gives details of a wide variety of remedies that were observed or reported by inhabitants around that time. Some of these remedies are interesting for their relevance to the period but others are of doubtful merit. These are reviewed here more for their significance in the understanding of the diseases and conditions of humans and even in some cases animals at that time. Introductions by Charles Withers and R.W. Munro, 11 and re-assessments of the contributions of Martin and colleagues of that time have given insight into the health and condition of peoples of the Western Isles of Scotland(the Occidental) (Martin 1695; Martin 1716).

Seasonal characteristics of scarlet fever in Songjiang District, Shanghai in 2012-2021 / 公共卫生与预防医学

Objective To analyze the seasonal characteristics of scarlet fever in Songjiang District from 2012 to 2021, and to provide references for the prevention and control of scarlet fevers. Methods The incidence data of scarlet fever in Songjiang District from 2012 to 2021 were collected through the China Disease Prevention and Control Information System. The seasonal characteristics and peak of scarlet fever incidence were analyzed using concentration and circular distribution methods. Results The average annual reported incidence rate of scarlet fever in Songjiang District from 2012 to 2021 was 20.15/100 000. The M value of the concentration analysis was 0.18. The results of the circular distribution method showed that the peak day of scarlet fever from March to August was May 12, and the epidemic peak period was from April 3 to June 20. From September to February of the next year, the peak day of scarlet fever was December 21, and the epidemic peak period was from December 2 to January 9 of the next year. The differences were all statistically significant (P values were all less than 0.05). Conclusion The peaks of scarlet fever in Songjiang District mainly occur in May and December. It is suggested that the monitoring methods and prevention strategies should be adjusted in time according to Seasonal characteristics of scarlet fever.

Bibliometric and visual analysis of Chinese scarlet fever literature / 公共卫生与预防医学

Objective To analyze the research status and trend of scarlet fever literature in China, and to provide reference for subsequent research. Methods Three major Chinese databases, CNKI, Wanfang, and VIP, as well as Web of Science English database, were used to search for literature related to scarlet fever from 2000 to 2023. Citespace6.2.R2 software was used to statistically analyze the number of publications, authors, institutions and journals, co-cited literature, keyword clustering, and other literature characteristics of the literature. Results From 2000 to 2023, a total of 1 011 Chinese literature were included in the three major Chinese databases. Since 2011, the number of publications had gradually increased, but in recent years, the number of publications had decreased. The organization with the most publications was the Shenyang Center for Disease Control and Prevention. The cluster analysis of key words mainly formed 9 cluster tags, and the high-frequency keywords mainly included epidemic characteristics, epidemiology, incidence rate, etc. A total of 84 English literature were included in the WOS database, with an overall upward trend in publication volume. The institution with the most publications was the China Center for Disease Control and Prevention, and the most frequently cited journal was “LANCET INFECT DIS”.《Resurgence of scarlet fever in China: a 13-year population-based surveillance study》 was the most cited journal. After keyword cluster analysis, 9 cluster labels were mainly formed, and the keywords were mainly outbreak，Hong Kong, and Group A streptococcus. Conclusion Compared with the English literature, which mainly focuses on spatiotemporal aggregation, etiology and strain resistance, Chinese literature focuses more on epidemic surveillance, clinical features and quality nursing.

Characterization of the RofA regulon in the pandemic M1global and emergent M1UK lineages of Streptococcus pyogenes.

The standalone regulator RofA is a positive regulator of the pilus locus in Streptococcus pyogenes. Found in only certain emm genotypes, RofA has been reported to regulate other virulence factors, although its role in the globally dominant emm1 S. pyogenes is unclear. Given the recent emergence of a new emm1 (M1UK) toxigenic lineage that is distinguished by three non-synonymous SNPs in rofA, we characterized the rofA regulon in six emm1 strains that are representative of the two contemporary major emm1 lineages (M1global and M1UK) using RNAseq analysis, and then determined the specific role of the M1UK-specific rofA SNPs. Deletion of rofA in three M1global strains led to altered expression of 14 genes, including six non-pilus locus genes. In M1UK strains, deletion of rofA led to altered expression of 16 genes, including nine genes that were unique to M1UK. Only the pilus locus genes were common to the RofA regulons of both lineages, while transcriptomic changes varied between strains even within the same lineage. Although introduction of the three SNPs into rofA did not impact gene expression in an M1global strain, reversal of three SNPs in an M1UK strain led to an unexpected number of transcriptomic changes that in part recapitulated transcriptomic changes seen when deleting RofA in the same strain. Computational analysis predicted that interactions with a key histidine residue in the PRD domain of RofA would differ between M1UK and M1global. RofA is a positive regulator of the pilus locus in all emm1 strains but effects on other genes are strain- and lineage-specific, with no clear, common DNA binding motif. The SNPs in rofA that characterize M1UK may impact regulation of RofA; whether they alter phosphorylation of the RofA PRD domain requires further investigation.

Stevens-Johnson syndrome: a case report of possible cephalosporin-induced cutaneous adverse reaction.

A severe medical condition known as Stevens-Johnson syndrome (SJS) is marked by a cutaneous and mucosal reaction from the use of specific medications. The prodromal illness is followed by severe mucocutaneous symptoms in this immune-mediated disease. We describe the clinical history of a 55-year-old Caucasian woman who was exposed to cephalosporins. In resource-constrained countries and hospitals where cutaneous biopsy is not readily available, it is not easy to diagnose Steven Johnson Syndrome. This is particularly true in countries where the incidence of infectious diseases such as scarlet fever and measles is high and the early symptoms of SJS can be mistaken for these conditions. We used the Naronjo scale to confirm the probable association of the drug with the syndrome. Physicians while writing prescriptions for their patients need to warn them of potential side effects and they should keep in mind conditions like Stevens-Johnson syndrome. This case report highlights the need for improved knowledge and understanding of SJS among healthcare practitioners in resource-limited communities where the prevalence of infectious diseases is high.

Regional differences in historical diphtheria and scarlet fever notification rates in The Netherlands, 1905-1925: a spatial-temporal analysis.

BACKGROUND: We describe how rates of two frequently occurring notifiable diseases-diphtheria and scarlet fever-varied between regions of The Netherlands in the early twentieth century, and identify potential factors underlying this variation. METHODS: Digitized weekly mandatory notification data for 1905-1925, municipality level, were aggregated into 27 'spatial units' defined by unique combinations of province and population density category (high: more than 4500; mid : 1250-4500; low: less than 1250 inhabitants km-2). Generalized additive regression models were fitted to estimate the associations between notification rates and population density, infant mortality rate and household income, while adjusting for temporal trends per spatial unit. RESULTS: Annual per capita notification rates for both diphtheria and scarlet fever tended to rise from the beginning of the period 1905-1925 until peaking around 1918/1919. Adjusted diphtheria notification rates were higher for high- and mid- compared with low-density municipalities (by 71.6 cases per 100 000, 95% confidence interval (CI) : 52.7-90.5; 39.0/100 k, 95% CI : 24.7-53.3, respectively). Scarlet fever showed similar associations with population density (35.7 cases per 100 000, 95% CI : 9.4-62.0; 21.4/100 k, 95% CI: 1.5-41.3). CONCLUSIONS: There was considerable spatial variation in notification rates for both diseases in early twentieth century Netherlands, which could partly be explained by factors capturing variation in living conditions and socio-economic circumstances. These findings aid understanding of contemporary respiratory infection transmission.

Streptococcus pyogenes Lineage ST62/emm87: The International Spread of This Potentially Invasive Lineage.

Streptococcus pyogenes is known to be associated with a variety of infections, from pharyngitis to necrotizing fasciitis (flesh-eating disease). S. pyogenes of the ST62/emm87 lineage is recognized as one of the most frequently isolated lineages of invasive infections caused by this bacterium, which may be involved in hospital outbreaks and cluster infections. Despite this, comparative genomic and phylogenomic studies have not yet been carried out for this lineage. Thus, its virulence and antimicrobial susceptibility profiles are mostly unknown, as are the genetic relationships and evolutionary traits involving this lineage. Previously, a strain of S. pyogenes ST62/emm87 (37-97) was characterized in our lab for its ability to generate antibiotic-persistent cells, and therapeutic failure in severe invasive infections caused by this bacterial species is well-reported in the scientific literature. In this work, we analyzed genomic and phylogenomic characteristics and evaluated the virulence and resistance profiles of ST62/emm87 S. pyogenes from Brazil and international sources. Here we show that strains that form this lineage (ST62/emm87) are internationally spread, involved in invasive outbreaks, and share important virulence profiles with the most common emm types of S. pyogenes, such as emm1, emm3, emm12, and emm69, which are associated with most invasive infections caused by this bacterial species in the USA and Europe. Accordingly, the continued increase of ST62/emm87 in severe S. pyogenes diseases should not be underestimated.

Early Warning and Prediction of Scarlet Fever in China Using the Baidu Search Index and Autoregressive Integrated Moving Average With Explanatory Variable (ARIMAX) Model: Time Series Analysis.

BACKGROUND: Internet-derived data and the autoregressive integrated moving average (ARIMA) and ARIMA with explanatory variable (ARIMAX) models are extensively used for infectious disease surveillance. However, the effectiveness of the Baidu search index (BSI) in predicting the incidence of scarlet fever remains uncertain. OBJECTIVE: Our objective was to investigate whether a low-cost BSI monitoring system could potentially function as a valuable complement to traditional scarlet fever surveillance in China. METHODS: ARIMA and ARIMAX models were developed to predict the incidence of scarlet fever in China using data from the National Health Commission of the People's Republic of China between January 2011 and August 2022. The procedures included establishing a keyword database, keyword selection and filtering through Spearman rank correlation and cross-correlation analyses, construction of the scarlet fever comprehensive search index (CSI), modeling with the training sets, predicting with the testing sets, and comparing the prediction performances. RESULTS: The average monthly incidence of scarlet fever was 4462.17 (SD 3011.75) cases, and annual incidence exhibited an upward trend until 2019. The keyword database contained 52 keywords, but only 6 highly relevant ones were selected for modeling. A high Spearman rank correlation was observed between the scarlet fever reported cases and the scarlet fever CSI (rs=0.881). We developed the ARIMA(4,0,0)(0,1,2)(12) model, and the ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0) and ARIMAX(1,0,2)(2,0,0)(12) models were combined with the BSI. The 3 models had a good fit and passed the residuals Ljung-Box test. The ARIMA(4,0,0)(0,1,2)(12), ARIMA(4,0,0)(0,1,2)(12) + CSI (Lag=0), and ARIMAX(1,0,2)(2,0,0)(12) models demonstrated favorable predictive capabilities, with mean absolute errors of 1692.16 (95% CI 584.88-2799.44), 1067.89 (95% CI 402.02-1733.76), and 639.75 (95% CI 188.12-1091.38), respectively; root mean squared errors of 2036.92 (95% CI 929.64-3144.20), 1224.92 (95% CI 559.04-1890.79), and 830.80 (95% CI 379.17-1282.43), respectively; and mean absolute percentage errors of 4.33% (95% CI 0.54%-8.13%), 3.36% (95% CI -0.24% to 6.96%), and 2.16% (95% CI -0.69% to 5.00%), respectively. The ARIMAX models outperformed the ARIMA models and had better prediction performances with smaller values. CONCLUSIONS: This study demonstrated that the BSI can be used for the early warning and prediction of scarlet fever, serving as a valuable supplement to traditional surveillance systems.

Patterns in the Incidence of Scarlet Fever Among Children Aged 0-9 Years - China, 2010-2019.

Introduction: This study investigates the patterns of scarlet fever among Chinese children aged 0-9 years from 2010 to 2019. The objective is to provide insights that may inform potential adjustments to China's current prevention and control tactics for this illness. Methods: The present study utilized data on the occurrence of scarlet fever in children from 2010 to 2019, sourced from the National Notifiable Disease Reporting System database, managed by the Chinese Center for Disease Control and Prevention. This research implemented SAS9.4 software to construct trajectory models representing the temporal incidence of scarlet fever, accounting for key variables such as sex, geographic region, urban versus rural dwellings, and various age brackets. Results: From 2010 to 2019, a total of 554,695 scarlet fever cases were reported among children aged 0-9 years in the 31 mainland Chinese provincial-level administrative divisions, signifying a rate of 35.36 per 100,000 individuals. An inconsistent yet generally rising trend was observed, evidenced by a 3.17-fold increase in reported cases and a 3.02-fold escalation in incidence rate over this period. Examination of these trends revealed three distinctive developmental patterns for both males and females, with the lowest prevalence in the first trajectory and the highest in the third. The incidence was consistently higher among males than females in all trajectories. The urban and northern regions displayed equal or greater trajectory rates than their rural and southern counterparts, respectively. In terms of age groups, the lowest incidence was observed in the 0-1-year age group, while the highest was recorded in the 4-5 and 6-7-year age groups. Conclusions: Between 2010 and 2019, there was a marked increase in the incidence of scarlet fever among children in China. The disease predominantly impacts urban-dwelling children, ranging from 4 to 7 years old, in the northern regions of the country. The incidence is reported to be higher among boys compared to girls.

Epidemiological characteristics of common respiratory infectious diseases in children before and during the COVID-19 epidemic.

Background: Since the outbreak of coronavirus disease 2019 (COVID-19), public's awareness of infection prevention and control has increased overall, and various prevention and control measures have been adopted. These measures may also have a certain impact on the occurrence of other infectious diseases. Therefore, we collected information on children with several respiratory infectious diseases in Jinan Children's Hospital in China from 2016 to 2022 and analyzed their changes. Method: We collected data on age, sex and number of cases of pertussis, measles, scarlet fever, pulmonary tuberculosis, mumps and influenza, which were diagnosed by clinical and laboratory criteria, from 1 January 2016 to 31 December 2022 in Jinan Children's Hospital in Jinan, Shandong Province, China. Data on the number of people affected by these diseases in China from the Chinese Center for Disease Control and Prevention were compared. Then, we processed the data by using WPS Excel 2019 and SPSS. Results: A total of 12,225 cases were included in this study in Jinan Children's Hospital, which consisted of 3,688 cases of pertussis (2,200 cases before COVID-19 and 1,488 during COVID-19), 680 cases of measles (650 cases before COVID-19 and 30 during COVID-19), 4,688 cases of scarlet fever (4,001 cases before COVID-19 and 687 during COVID-19), 114 cases of tuberculosis (86 cases before COVID-19 and 28 during COVID-19), 449 cases of mumps (340 cases before COVID-19 and 109 during COVID-19) and 2,606 cases of influenza (1,051 cases before COVID-19 and 1,555 during COVID-19). The numbers of children in the hospital with pertussis, measles, scarlet fever, mumps and influenza decreased substantially during COVID-19 in 2020-2022 compared with numbers in 2016-2019, while numbers of patients in China with all six respiratory infectious diseases, including pulmonary tuberculosis, declined during the pandemic. A rebound of pertussis, scarlet fever and influenza was observed in 2021 and 2022. Conclusions: The study found that viral pathogens such as those causing measles, mumps and influenza all decreased during the pandemic, after which influenza rebounded. Infection diseases caused by bacteria such as scarlet fever and pertussis also decreased during COVID-19, and then a rebound occurred. However, tuberculosis stayed relatively constant.

The rise and fall of acute rheumatic fever and rheumatic heart disease: a mini review.

Introduction: The incidences of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), which were leading causes of death in children in the 1920s, have decreased substantially. Considering the recent resurgence of scarlet fever and increased incidence of streptococcal pharyngitis in children, an investigation of the current status of ARF and RHD may be worthwhile. Objective: To summarize the prevalence trends, pathogenic factors, and prevention strategies for ARF and RHD in children. Methods: A selective search of literature published between January 1920 and February 2023 was done in PubMed, using the terms "acute rheumatic fever", "rheumatic heart disease", "group A Streptococcus", "pharyngitis", "pharyngeal tonsillitis", "scarlet fever", "impetigo", "obstructive sleep apnea syndrome" and "child". Results: Overcrowded homes and inadequate sanitation led to recurrent group A streptococcal infection, and the causal relationship between group A streptococcal infection and ARF/RHD was well established. Streptococcal infectious diseases, such as group A streptococcal pharyngeal tonsillitis, SF, impetigo, and obstructive sleep apnea syndrome, were associated with the occurrence of ARF and RHD. ARF and RHD were still prevalent in young people of developing countries and economically poor populations of high-income countries. Universal disease registration systems were critical to locating disease outbreaks, tracking disease transmission, and identifying high-risk populations. Four-level prevention strategies were effective in reducing the incidence and mortality of ARF and RHD. Conclusions: Registry and preventive measures for ARF and RHD should be strengthened in areas of dense population; poor sanitation; resurgence of SF; and high incidence of streptococcal pharyngitis, impetigo, and obstructive sleep apnea syndrome.

Surveillance of noninvasive group A Streptococcus infections in French ambulatory pediatrics before and during the COVID-19 pandemic: a prospective multicenter study from 2018-2022.

OBJECTIVES: We evaluated the burden of noninvasive group A Streptococcus (GAS) infections in ambulatory pediatrics before and during the COVID-19 pandemic in France. METHODS: We analyzed data from a national network of ambulatory pediatricians between 2018 and 2022. Clinicians evaluating children ≤15 years old for tonsillopharyngitis, perianal infections, paronychia/blistering dactylitis, and scarlet fever were invited to perform a rapid antigen detection test (RADT) for GAS. Monthly incidence of noninvasive GAS infections per 10,000 visits was modeled using time series analysis, considering two breakpoints: March 2020 (first national lockdown) and March 2022 (end of mandatory mask-wearing in schools). RESULTS: Over the study period, 125 pediatricians recorded 271,084 infectious episodes. GAS-related illnesses represented 4.3% of all infections. In March 2020, the incidence of GAS diseases decreased by 84.5% (P <0.001), with no significant trend until March 2022. After March 2022, the incidence significantly increased (+23.8% per month, P <0.001), with similar patterns across all monitored GAS-related diseases. CONCLUSION: By using routine clinical data and RADTs, we have monitored changes in the incidence of noninvasive GAS infections in ambulatory pediatrics. COVID-19 mitigation measures have had a major impact on the epidemiology of noninvasive GAS infections, but their relaxation was followed by a surge above baseline levels.

Epidemiological characteristics and spatiotemporal clustering of scarlet fever in Liaoning Province, China, 2010-2019.

BACKGROUND: To explore the epidemiological characteristics and spatiotemporal distribution of scarlet fever in Liaoning Province, which could provide scientific evidence for the formulation and improvement of prevention and control strategies and measures. METHODS: Data on scarlet fever cases and population were obtained from the China Information System for Disease Control and Prevention in Liaoning Province between 2010 and 2019. We examined the spatial and spatiotemporal clusters of scarlet fever across Liaoning Province using the Moran's I, local indicators of spatial association, local Gi* hotspot statistics, and Kulldorff's retrospective space-time scan statistical analysis. RESULTS: Between 1st January 2010 and 31st December 2019, 46,652 cases of scarlet fever were reported in Liaoning Province, with an annual average incidence of 10.67 per 100,000. The incidence of scarlet fever had obvious seasonality with high incidence in early summer June and early winter December. The male-to-female ratio was 1.53:1. The highest incidence of cases occurred in 3-9 year old children. The most likely spatiotemporal cluster and the secondary clusters were detected in urban regions of Shenyang and Dalian, Liaoning Province. CONCLUSIONS: The incidence of scarlet fever has obvious spatiotemporal clustering, with the high-risk areas mainly concentrated in urban area of Shenyang and Dalian, Liaoning Province. Control strategies need to focus on high-risk season, high-risk areas and high-risk populations in order to reduce the incidence of scarlet fever.