Group A strep in children became a cause for concern again in winter 2022-2023, when invasive infections rose sharply among under-10s. The review published by Santé publique France (the French public health agency) on 19 December 2025 shows that the wave is receding. In 2024, the incidence of invasive forms fell by 27% and scarlet fever returned to pre-pandemic levels. No child's death certificate mentions group A strep for the 2024-2025 season. Levels nonetheless remain higher than in 2018-2019.
Here is what the review contains, figure by figure, and what it does, or doesn't, change for parents of a young child.
Group A strep in children: what are we talking about?
Group A streptococcus, or Streptococcus pyogenes, is a bacterium that “is transmitted exclusively between humans through respiratory droplets and direct contact”. It most often causes mild infections: tonsillitis, pharyngitis, scarlet fever, impetigo. More rarely, it causes serious invasive infections, sepsis, skin and soft-tissue infections, pleuropneumonia, meningitis, sometimes complicated by toxic shock syndrome. Santé publique France points out that the fatality rate of these invasive forms “is estimated at between 10 and 20%”.
Group A strep infections are seasonal: they “generally increase from September onwards”, are more common in winter and spring, and decrease in summer. Autumn 2026 therefore marks the start of a new season, which makes the review of the previous ones all the more relevant.
What happened in 2022-2023?
During the COVID-19 pandemic, in 2020 and 2021, circulation of group A strep fell sharply, probably as a result of public health measures. When these measures were lifted, the bacterium began circulating again, and a particular genotype, M1UK, emerged. The result was a resurgence “particularly among children, at the end of 2022”, also seen in several European countries, Japan and Australia.
The Epibac laboratory network gives a measure of it. In 2023, the incidence rate of invasive infections reached “6.2 cases per 100,000 inhabitants with 4,076 cases, an increase of 63% compared with the 2018-2019 period”. The rise particularly affected children under 10, up 42% on 2022, and adults aged 90 and over. The peak was reached in April 2023.
Electronic death certificates bear this out. Among children, the number of certificates mentioning a group A strep infection rose from 1 in the 2021-2022 season to 10 in 2022-2023.
Where do things stand in 2024 and 2025?
The December 2025 review describes a decline across all indicators.
Invasive infections
In 2024, the incidence rate “decreased (-27%) to 4.5 cases per 100,000 inhabitants”, an estimated 2,979 cases. The fall concerns children and adults alike. Levels nevertheless remain higher than before the pandemic, with 2,530 cases in 2019 and 2,097 in 2018. More than 95% of these invasive infections are bacteraemias, meaning the bacterium is present in the blood.
Strains received by the National Reference Centre
The National Reference Centre for streptococci (Centre national de référence) received 1,603 invasive strains in 2024, including 202 paediatric ones, compared with 3,172 in 2023. The proportion of children among patients fell back to 13% in 2024 and 9% in the first half of 2025, compared with 22% in 2022 and 19% in 2023. These levels are comparable to 2018 and 2019. In the first half of 2025, the number of strains received was “less than half that of 2024”. Santé publique France cautiously sees this as a stabilisation or a slight decrease, a “hypothesis yet to be confirmed”.
Severity in children
Among under-18s, pleuropulmonary forms, which accounted for 27% of invasive infections in 2022, fell back to 12% in 2024 and 8% in the first half of 2025. The proportion of cases complicated by toxic shock went from 12% in 2022 to 8% in 2024 and 3% in the first half of 2025. It is thus returning “to levels observed in 2018 and 2019”.
Deaths
Across all ages, 104 electronic death certificates mentioned a group A strep infection for the 2022-2023 season, 72 in 2023-2024 and 50 in 2024-2025. Among children, the figure went from 10 in 2022-2023 to 2 in 2023-2024, then to “zero in 2024-2025”. Santé publique France notes that the completeness of these certificates, estimated at 47% in 2024 and 70% for hospital deaths, improves over time. This suggests “that the actual fall in deaths could be even more marked”.
Is scarlet fever back to normal?
Yes, according to the two syndromic surveillance indicators. SOS Médecins consultations (a French out-of-hours home-visit doctor service) and emergency department visits for scarlet fever among under-15s remained high during the 2023-2024 season. Since the end of 2024, they have “returned to levels observed in the seasons before the COVID-19 epidemic”. The 2024-2025 season resembles the 2018-2019 season.
For parents, this means that scarlet fever remains a common childhood illness, but it is no longer in the resurgence phase that marked 2022 and 2023. Exclusion from nursery in case of scarlet fever, and returning two days after starting antibiotics, are covered in our article on a poorly baby at nursery.
The M1UK genotype and antibiotic resistance
The 2022-2023 surge was linked to emm1 strains, and in particular to the emerging M1UK genotype, which accounted for 56% of the emm1 strains analysed in 2022 and 2023. Data from the National Reference Centre have since shown “a significant decrease” in these strains, in favour of the emm3 and emm4 genotypes, a trend also observed elsewhere in Europe.
On antibiotics, the review is reassuring: all strains tested since 2012 “are susceptible to β-lactams”, the family that includes amoxicillin, which remains the first-line treatment. In children, macrolide resistance remains low, at 3.2% of strains in 2024. An uncommon genotype, emm77, shows high co-resistance to macrolides and tetracyclines and is under specific surveillance. Our article on the appropriate use of antibiotics in babies points out that a sore throat before the age of 3 is almost always viral and is not tested for.
What should parents of a young child take away?
The review contains no new recommendations, and that in itself is useful information. The helpful habits remain those for any respiratory infection.
- Handwashing, for children and adults alike, is the first protective measure cited by Santé publique France from the December 2022 alert onwards. Our tips for learning to wash hands apply from 18 months.
- Coughing into the crook of the elbow and wearing a mask, for any adult with a cold who is caring for a baby.
- Monitoring fever without masking it. A fever reducer relieves symptoms but tells you nothing about the cause. Our articles on fever in babies and on paracetamol doses by weight give the official guidance.
- Seeing a doctor without delay in case of a poorly tolerated fever, a rapid deterioration in general condition, a spreading rash or intense localised pain. These are reasons for urgent medical attention, whatever the cause.
- Not self-prescribing antibiotics or reusing leftover treatment: the decision is based on an examination and, from the age of 3, on a rapid test.
Puerperal infections, which affect the mother in the days following childbirth, are monitored separately. Reports fell in 2024, with 25 reports and no deaths, then 15 reports covering 23 cases in the first half of 2025. Santé publique France points out that these deaths, though rare, “are nonetheless tragic and preventable”: a fever after giving birth should always be reported.
Key takeaways
The 2022-2023 wave of group A strep infections, which mainly hit children under 10, has been receding since 2024: incidence down 27%, severe forms and child deaths falling, scarlet fever back to its usual level, the M1UK genotype in decline. Levels remain above pre-pandemic figures, and the bacterium is still susceptible to amoxicillin. For families, nothing changes in everyday habits: clean hands, fever monitored, prompt medical advice for any unusual sign.
Sources
- Santé publique France, “Bilan des infections invasives à streptocoque A en France, 2018-2025 (données disponibles au 31 août)”, national bulletin, 19 December 2025.
- Santé publique France, “Infection invasive à streptocoque du groupe A (IISGA) : point de situation au 6 décembre 2022”, news item of 6 December 2022.
