Invasive Strep A Cases Increase in the US, Internationally

The CDC is investigating a potential reported increase in group A streptococcal (iGAS) infections in the US pediatric population.

“It is too early to tell if iGAS case numbers are just returning to pre-pandemic levels or if they are increasing beyond what we would normally expect based on what we know about the seasonal patterns of GAS ‘ wrote Kate Grusich, spokeswoman for the CDC, in an email reported by CNN.

This particular grouping of serious infections includes life-threatening conditions such as blood-infected cellulitis, necrotizing fasciitis, pneumonia, and toxic streptococcal syndrome.

Cases have risen in some western states, including Texas, Colorado, Washington and Arizona.

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 streptococcal infection in children in the Denver metro area since November 1. The state agency identified the youngest patient cases as ranging in age from 10 months to 6 years, and two were known to have died among those cases. Both were small children who were not yet of school age. The official cause of death has not yet been determined. CDPHE noted that the last reported death of a pediatric patient with group A streptococcus in Colorado was in 2018.

“Although they remain rare, CDPHE sees invasive group A streptococcal infections in Colorado that cause serious illness,” said Dr. Rachel Herlihy, state epidemiologist, CDPHE, in a statement. “There is no vaccine for group A strep, but staying up to date on vaccines for COVID-19, influenza, and chickenpox can help protect your child from complications from 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 that local and state health officials routinely contact labs to identify all cases and then report those cases to the CDC.

For healthcare professionals, the CDC recommends the following:

Notify your local or state health department as soon as possible of any unusually aggressive or severe iGAS infection in children or potential increases or clusters of iGAS infections
Ask labs to keep GAS isolates or send them to the State Public Health Laboratory for temporary storage.

According to the CDC website, the federal agency estimates: “Over the past five years, approximately 14,000 to 25,000 cases of invasive group A streptococcal disease occur in the United States each year. Between 1,500 and 2,300 people have died annually from invasive group A streptococcal disease for the past five years.”

The United Kingdom Health Security Agency (UKHSA) issued a report last week stating they have seen an increase in incidence rates as well as deaths from iGAS.

In a statement released Dec. 2 and updated Dec. 15, the agency reported that there were 111 iGAS cases in children ages 1 to 4, compared to 194 cases in that age group for the full year of the last comparable peak year 2017 gave 2018, the UKHSA reported. In addition, the agency said there were 74 cases in children ages 5 to 9, compared to 117 for the full year of the last comparable peak season of 2017-2018. The majority of cases continue to occur in children over the age of 15.

“There have been 74 deaths across all age groups in England so far this season,” UKHSA wrote in a released statement. “That number includes 16 children under the age of 18 in England. In the 2017-2018 season there was a total of 355 deaths over the entire season, including 27 deaths in children under the age of 18.”

Stay awake
Group A streptococci can cause sore throat, scarlet fever, and impetigo. Although these conditions are less serious and much more common, they should be monitored by health care providers and children’s families.

“It’s very rare for a child to become more seriously ill, but parents know better than anyone what their child is normally like, so you know when they’re not reacting as they normally would,” Dr. Colin Brown, Deputy Director, UKHSA, said in a statement. “Make sure you talk to a doctor if your child gets worse after a bout of scarlet fever, a sore throat, or a respiratory infection — look out for signs like a fever that won’t go down, dehydration, extreme tiredness, intense muscle pain, or difficulty breathing rapid breathing.”

For parents, the CDC recommends the following:

Learn about the symptoms of necrotizing fasciitis and streptococcal toxic shock syndrome
See a doctor quickly if you think your child has any of these infections
Make sure your children are up to date with flu and chickenpox vaccines, as these infections can increase the risk of iGAS infection.

prevent spread
Public health officials are reminding families that good hand and respiratory hygiene is important to stop the spread of many germs.

“Stay at home if you are sick and practice good hand hygiene – wash your hands regularly 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 to touch. Call your child’s doctor if they develop new or worsening symptoms of an illness,” added CDPHE’s Herlihy.