Invasive Strep A Cases Increase in the US, Internationally

The CDC is investigating a potential reported uptick of group A streptococci (iGAS) infections in the pediatric population in the US.

“It’s too soon to say whether iGAS case numbers are just returning to pre-pandemic levels or if they are rising beyond what we would normally expect based on what we know about GAS seasonal patterns,” CDC spokesperson Kate Grusich wrote in an email that was reported by CNN.

This particular grouping of severe infections includes life-threatening conditions such cellulitis with blood infection, necrotizing fasciitis, pneumonia, and streptococcal toxic syndrome.

A few western states including Texas, Colorado, Washington, and Arizona have seen increases in the number of cases.

On December 15, the Colorado Department of Public Health and Environment (CDPHE) released a statement reporting that there have been 11 cases of invasive group A strep in children in the Denver metro area since November 1. The state agency said the most recent patient cases range in age from 10 months to 6 years, and it was aware of two deaths among these cases. Both were young children who were not yet school aged. The official cause of death has not been finalized. CDPHE noted the last reported death in a pediatric patient with group A strep in Colorado was in 2018.

“While they remain rare, CDPHE is seeing invasive group A strep infections in Colorado that cause severe illness,” Dr. Rachel Herlihy, state epidemiologist, CDPHE, said in a statement. “There is no vaccine for group A strep, but keeping up to date on vaccines for COVID-19, flu, and chickenpox can help protect your child from developing complications from a group A strep infection."

CDC Surveillance
CDC tracks invasive group A strep infections through Active Bacterial Core surveillance (ABCs), a population-based, active- and laboratory-based surveillance system. This means local and state health departments routinely contact laboratories to identify all cases, then report those cases to CDC.

For healthcare professionals, the CDC recommends the following:

• Notify their local or state public health department as soon as possible about unusually aggressive or severe iGAS infections among children or potential increases or clusters of iGAS infections
• Ask laboratories to hold GAS isolates or send them to the state public health laboratory for temporary storage.

According to the CDC’s website, the federal agency estimated, “in the most recent five years, approximately 14,000 to 25,000 cases of invasive group A strep disease occur each year in the United States. In the last five years between 1500 and 2300 people die annually due to invasive group A strep disease.”

The United Kingdom Health Security Agency (UKHSA) gave a report last week that said they have witnessed an uptick in incidence rates as well as deaths from iGAS.

In a statement released on December 2 and updated on December 15, the agency reported that there had been 111 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season in 2017 to 2018, the UKHSA reported. In addition, the agency said that there had been 74 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of cases continue to be in those over 15 years.

“So far this season there have been 74 deaths across all age groups in England,” UKHSA wrote in a released statement. “This figure includes 16 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.”

Keeping Vigilant
The group A strep can cause step throat, scarlet fever, and impetigo. Although these conditions are less severe and seen much more frequently, they should be monitored by healthcare providers and families of children.

“It is very rare that a child will go on to become more seriously ill, but parents know better than anyone else what your child is usually like, so you’ll know when they are not responding as they would normally,” Dr. Colin Brown, Deputy Director, UKHSA, said in a statement. “Make sure you speak to a healthcare professional if your child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection—look out for signs such as a fever that won’t go down, dehydration, extreme tiredness, intense muscle pains, difficulty breathing or breathing very fast.”

For parents, the CDC recommends the following:

• Learn about the symptoms for necrotizing fasciitis and streptococcal toxic shock syndrome
• Seek medical care quickly if they think their child has one of these infections
• Make sure their children are up to date with flu and chickenpox vaccines, since getting these infections can increase risk for getting an iGAS infection.

Preventing Spread
Public health officials remind families that good hand and respiratory hygiene are important for stopping the spread of many germs.

“Stay home when you are sick and practice good hand hygiene—regularly wash your hands with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer with at least 60% alcohol and avoid touching your face. Call your child’s doctor if they are experiencing new or worsening symptoms of an illness,” CDPHE’s Herlihy added.