Outbreak of severe community-acquired bacterial infections among children in North Rhine-Westphalia (Germany), October to December 2022
Infection, vol. 52, pp. 1099–1111
Abstract
PURPOSE: In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences. METHODS: Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016-2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics. RESULTS: In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9). DISCUSSION: The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae. Improved precautionary measures are needed to attenuate future outbreaks.
Authors 66
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Mark van der Linden Aachen Department of Medical Microbiology German Reference Laboratory for Streptococci
RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
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Andreas Itzek Aachen Department of Medical Microbiology German Reference Laboratory for Streptococci
RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
German Reference Laboratory for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Affiliation as printed
Department of General Pediatrics, Klinikum Oberberg, Kreiskrankenhaus Gummersbach, Gummersbach, Germany
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Helios Kliniken · Helios Hospital Schwerin
Affiliation as printed
Department of General Pediatrics, Helios Hospital Schwelm, Schwelm, Germany
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Affiliation as printed
Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
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Affiliation as printed
Department of Pediatrics, Agaplesion Hospital Hagen, Hagen, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Florence Nightingale Hospital Kaiserswerth, Düsseldorf, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Protestant Hospital Bethel, University of Bielefeld, Bielefeld, Germany
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Affiliation as printed
Department of Pediatrics, Sankt Franziskus Hospital Münster, Münster, Germany
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RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Sana Hospitals Duisburg, Duisburg, Germany
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Affiliation as printed
Division of Neonatology, Department of Pediatrics and Adolescent Medicine, GFO Hospital Bonn, Bonn, Germany
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Affiliation as printed
Department of General Pediatrics, DRK Hospital Kirchen, Kirchen, Germany
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Affiliation as printed
Department of Pediatrics, Pediatric Intensive Care Medicine, St. Vinzenz Hospital Paderborn, Paderborn, Germany
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Affiliation as printed
Department of General Pediatrics, GFO Hospital Dinslaken, Dinslaken, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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University of Cologne · University Hospital Cologne
Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital, University of Cologne, Cologne, Germany
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Evangelisches Krankenhaus Oberhausen
Affiliation as printed
Department of General Pediatrics, Evangelical Hospital Oberhausen, Oberhausen, Germany
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Affiliation as printed
Department of General Pediatrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
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Affiliation as printed
Department of General Pediatrics, Lukas-Hospital Neuss, Neuss, Germany
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Affiliation as printed
Department of General Pediatrics, Märkisch Hospital Lüdenscheid, Lüdenscheid, Germany
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Evangelisches Krankenhaus Düsseldorf
Affiliation as printed
Department of General Pediatrics, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
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Affiliation as printed
Department of General Pediatrics, Marien-Hospital Witten, Witten, Germany
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Städtische Kliniken Mönchengladbach
Affiliation as printed
Department of General Pediatrics, Städtische Kliniken Mönchengladbach, Elisabeth-Hospital Rheydt, Mönchengladbach, Germany
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Affiliation as printed
Department of Pediatrics and Adolescent Medicine, Sankt Agnes Hospital, Bocholt, Germany
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Affiliation as printed
Department of General Pediatrics, Hospital Soest gGmbH, Soest, Germany
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RWTH Aachen University · Universitätsklinikum Aachen
Affiliation as printed
Division of Neonatology, Department of Pediatrics, University Hospital, RWTH University of Aachen, Aachen, Germany
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Witten/Herdecke University · Helios Universitätsklinikum Wuppertal
Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
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Affiliation as printed
Department of General Pediatrics, Mathias-Stiftung, Rheine, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital, Amsterdamer Str., Cologne, Germany
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Asklepios Klinik Sankt Augustin
Affiliation as printed
Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
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Affiliation as printed
Department of Pediatrics and Adolescent Medicine, Hochsauerland Hospital, Arnsberg, Germany
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Affiliation as printed
Department of General Pediatrics, Marien-Hospital gGmbH, Wesel, Germany
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Witten/Herdecke University · Gemeinschaftskrankenhaus Herdecke
Affiliation as printed
Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, University of Witten/Herdecke, Herdecke, Germany
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Heinrich Heine University Düsseldorf
Affiliation as printed
Division of Neonatology and Pediatric Cardiology, Department of General Pediatrics, Heinrich Heine University, Düsseldorf, Germany
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Affiliation as printed
Department of Neonatology and Pediatric Intensive Care Medicine, University of Bonn, Bonn, Germany
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Affiliation as printed
Department of General Pediatrics, Marien-Hospital Gelsenkirchen, Gelsenkirchen, Germany
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Affiliation as printed
Division of Oncology and Haematology, Department of General Pediatrics, Hospital of Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
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Affiliation as printed
Department of Pediatrics, Elisabeth-Hospital Essen, Essen, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Helios Hospital Krefeld, Krefeld, Germany
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Affiliation as printed
Department of General Pediatrics, DRK Hospital Siegen gGmbH, Siegen, Germany
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Affiliation as printed
Department of General Pediatrics, Porz, Cologne, Germany
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Ruhr University Bochum · University Hospitals of the Ruhr-University of Bochum
Affiliation as printed
Division of Neonatology and Pediatric Intensive Care, University Children's Hospital, Ruhr University of Bochum, Bochum, Germany
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Affiliation as printed
Department of General Pediatrics, St. Antonius Hospital Kleve, Kleve, Germany
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Affiliation as printed
Department of Pediatrics, Clemenshospital Münster, Münster, Germany
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Affiliation as printed
Department of General Pediatrics, Evangelical Hospital Lippstadt, Lippstadt, Germany
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Affiliation as printed
Department of General Pediatrics, Municipal Hospital Solingen, Solingen, Germany
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Affiliation as printed
Department of Pediatrics, Helios Clinic Duisburg, Duisburg, Germany
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Evangelisches Krankenhaus Hamm
Affiliation as printed
Division of Neonatology and Pediatric Intensive Care, Evangelical Hospital Hamm, Hamm, Germany
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Affiliation as printed
Department of General Pediatrics, Herford, Germany
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Affiliation as printed
Department of Pediatrics, St.-Clemens-Hospital Geldern, Geldern, Germany
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Affiliation as printed
Department of General Pediatrics, Sana-Hospital Remscheid, Remscheid, Germany
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Affiliation as printed
Department of General Pediatrics, AKH Hospital Viersen, Viersen, Germany
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University of Münster · University Hospital Münster
Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital Münster, Münster, Germany
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Evangelisches Krankenhaus Oberhausen
Affiliation as printed
Department of General Pediatrics, Hospital Oberhausen Sterkrade gGmbH, Oberhausen, Germany
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Affiliation as printed
Department of General Pediatrics, Bethanien Hospital Moers, Moers, Germany
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Affiliation as printed
Department of Pediatrics, Helios Medical Center Niederberg, Velbert, Germany
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Affiliation as printed
Division of Pediatric Intensive Care, Department of Pediatrics, Bergmannsheil Pediatric Hospital Gelsenkirchen Buer, Gelsenkirchen, Germany
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Affiliation as printed
Department of Pediatrics and Adolescent Medicine, Christophorus Hospital, Coesfeld, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Affiliation as printed
German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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Affiliation as printed
German National Reference Laboratory for Meningococci and Haemophilus Influenzae, Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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Nora Bruns corresponding
Essen University Hospital · University of Duisburg-Essen
Affiliation as printed
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany. nora.bruns@uk-essen.de
Department of Pediatrics I (Neonatology, Pediatric Intensive Care, Pediatric Neurology, and Pediatric Infectious Diseases), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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