Epidemiology and outcome of necrotizing Fasciitis in children: An active surveillance study of the Canadian paediatric surveillance program

Objective To describe the epidemiology, management, and outcome of pediatric necrotizing fasciitis (NF) in Canada before full implementation of varicella immunization programs. Study design This was a prospective cohort study of all children under age 16 years identified by the Canadian Paediatric Surveillance Program (CPSI'). Results Between November, 1, 2001 and October 31, 2003, 36 NF cases were identified (mean age, 5.9 +/- 5 years). Group A streptococcus (GAS)-related and non-GAS-related NF accounted for 2.12 and 0.81 cases per million children, respectively. The annual incidence was substantially higher in children under age 5 years (5.9 vs 1.8 per million; P = .0002). Males over age 1 year had the highest disease burden, with 12 cases per million, versus 3.2 cases per million for females under age 1 year (P < . 0001). Most (15/26; 58%) GAS-related cases were associated with varicella. Complications occurred in 29 children (78%), and 2 children (5.4%) died. Conclusion In the prevaccine era, NF occurred most commonly in Canadian children under age 5 years, with a peak incidence in males under age 1 year. There is substantial associated morbidity and about 5% mortality. The data provide baseline incidence of disease and a surveillance mechanism for NF after the implementation of publicly funded varicella immunization programs in Canada.