The U.S. Centers for Disease Control and Prevention have issued a warning about a recent increase in invasive infections of strep A in children after at least two kids in the U.S. and 15 in the U.K. have died.
Group A streptococcus is a type of bacteria that can cause a range of illness, from strep throat and scarlet fever to skin infections. An invasive case of strep A refers to when the bacteria spread to parts of the body that they don't normally reach, like the bloodstream. This can cause severe and even fatal illness and requires immediate treatment with antibiotics, according to the CDC warning.
The CDC said it was first notified about a rise in infections in the U.S. in November 2022, when a hospital in Colorado saw a possible increase strep A cases, followed by a potential increase "in other states," per the warning. It did not specify which states. The agency added that in some parts of the country, the increase in strep A is occurring at the same time as "increased circulation" of respiratory syncytial virus, influenza, COVID-19 and other respiratory viruses.
"While the overall number of cases has remained relatively low and (invasive Group A strep) infections remain rare in children, CDC is investigating these reports," the agency said.
NBC News previously reported that hospitals in Arizona, Colorado, Texas and Washington confirmed that they've seen more cases than usual of invasive Group A strep. In Colorado, two children, who were less than school age, have died from the infection since Nov. 1; the last time anyone in the state died from strep A was in 2018. The Denver Health Department told NBC News it has received reports of 11 cases — all in children between 10 months and 6 years old — since Nov. 1. In Texas, one hospital has seen an increase of four times in the number cases of invasive strep A this year, NBC News reported.
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The CDC estimates that there are several million cases of noninvasive strep A in the U.S. every year — which includes strep throat, scarlet fever and the bacterial skin infection impetigo. Over the past five years, there have been between 14,000 and 25,000 cases of invasive strep per year and 1,500 to 2,300 deaths per year.
In the U.K., at least 21 children have died from invasive strep A since September, per the U.K. Health Security Agency. According to the World Health Organization, at least five countries in Europe (U.K., France, Ireland, the Netherlands, Sweden) have seen an increase in invasive strep A cases, primarily in kids under 10.
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What is invasive strep A?
Strep A refers to the diseases that come from being infected with the bacteria called Group A streptococcus. Noninvasive illnesses from strep A, according to the CDC, include:
- Strep throat, which causes sore throat, pain with swallowing and fever. It's “a mild and common condition that can be easily treated,” according to the Colorado Department of Public Health and Environment.
- Scarlet fever, which commonly causes rash and fever.
- Impetigo, a highly contagious bacterial skin infection that starts as raised bumps on the skin followed by blisters containing pus followed by crusty lesions.
An invasive strep A infection — which is what the CDC is currently investigating — refers to when the bacteria spread outside the throat or skin (where they tend to cause only mild symptoms) and into the bloodstream, lungs, fluid in the spinal cord or "other places inside the body they would not typically live," per the Colorado health department.
Conditions that result from an invasive strep A infection include:
- Cellulitis (a bacterial infection in the tissue under the skin) with a blood infection.
- Pneumonia, an infection in the lungs.
- Necrotizing fasciitis, popularly known as flesh-eating disease.
- Streptococcal toxic shock syndrome (STSS), "which can develop very quickly into low blood pressure, multiple organ failure, and even death," per the CDC.
Strep A is spread through contact with droplets from an infected person when they cough, sneeze or talk. Cases of Group A strep tend to follow a seasonal pattern, peaking between December and April in the U.S. It's most common in kids 5 to 15 years old.
Why is strep A causing more severe infections?
It’s not currently known whether the spike in cases is due to one specific Group A strep strain, Dr. Michael Green, medical director of infection prevention and antimicrobial stewardship at the UPMC Children’s Hospital of Pittsburgh and a professor of pediatrics and surgery at the University of Pittsburgh, tells TODAY.com.
There are several hundred strains of Group A strep, and it’s possible that “a particularly nasty strain” has become more prominent in the parts of the country reporting increases, Green says, adding that until all the information on the strains from those places has been analyzed we won’t know.
Unlike COVID-19, where one variant can become dominant, “different areas of the country can have different strains of Group A in circulation,” Green says. “You can have a nasty Group A strep in Ohio, but not in Pittsburgh. But you worry that it might get here from people who are traveling.”
Green says the Children’s Hospital of Pittsburgh has not seen a bump in the number of cases this year as compared to those 2014 to 2017, but there may be an increase in the severity of this year’s cases.
It’s likely that the rise in cases in some locations is tied to the increase in viral illnesses — the flu, RSV and possibly COVID-19, Green says. Viruses like the flu can damage the small airways and make them more vulnerable to bacterial infections, he explains.
“Whenever we see a huge amount of respiratory viruses, we know we are going to see a bump up in bacterial infections,” Green says.
A factor that has confused the issue is that viruses such as RSV and influenza have sparked early this year, says Dr. Jason Zucker, an assistant professor of medicine at the Columbia University Vagelos College of Physicians and Surgeons in New York City.
“We’re seeing a lot of things in different seasons this year than we normally would,” Zucker tells TODAY.com. “So it’s not clear if there’s a change in the epidemiological pattern.”
The CDC noted in its warning that, in the past, the U.S. has seen increased rates of invasive strep A when flu activity has also been high. The current U.S. flu season is one of the worst in recent years.
Currently there doesn’t seem to be an increase in invasive Group A strep in New York City hospitals, Dr. Ethan Wiener, chief of emergency medicine at NYU Langone Health Hassenfeld Children’s Hospital, tells TODAY.com. “In speaking to people locally, there have been only sporadic cases that I am aware of."
Signs of severe strep A infections
Because a viral infection can make a bacterial infection more likely, parents of kids who recently had a viral illness should be vigilant about possible Group A strep infections, Dr. Ishminder Kaur, a specialist in pediatric infectious diseases at the UCLA, David Geffen School of Medicine, tells TODAY.com.
Signs of a Group A strep infection, per the Colorado health department, include:
- Sore throat
- Fever
- Chills
- New rashes
- Skin bumps
- Painful red patches on the skin
High fever and labored breathing, as well as "difficulty coordinating swallowing with breathing" in young kids, "should trigger parents to call their provider or to seek emergency care, depending on the seriousness of the situation," Kaur says.
Wiener adds that a high fever by itself doesn't signal Group A strep and is "in no way harmful or dangerous." Parents should remember that if a child is very sick, it could be the flu, he says.
Signs a child's strep A infection may be invasive include:
- A change in mental status. "Maybe you’re not able to arouse the child, or the child may not be responding normally,” Wiener says. “That’s different from the child feeling blah or lying on the couch all day.”
- Early signs of necrotizing fasciitis, which, per the CDC, include: a red, warm or swollen area of skin that spreads quickly; severe pain, including pain beyond the area of the skin that is red, warm, or swollen; fever. Later-stage signs are: ulcers, blisters, or black spots on the skin; changes in the color of the skin; pus or oozing from the infected area; dizziness; fatigue; diarrhea or nausea.
- Early signs of streptococcal toxic shock syndrome, which, per the CDC, include: fever and chills, muscle aches, nausea and vomiting. Later signs, which usually develop 24 to 48 hours after the first symptoms, include: low blood pressure; faster than normal heart rate; rapid breathing; signs of organ failure, such as inability to produce urine or yellowing eyes.
While both necrotizing fasciitis and streptococcal toxic shock syndrome are rare, their symptoms can get worse quickly. So, in light of the strep A investigation, the CDC is urging parents to know the symptoms of both diseases and seek medical care quickly if they think their child has either.
Parents should also contact a health care provider right away if their child develops new or worsening symptoms during a viral infection, the Colorado health department advised.
How to prevent strep A infections
The CDC is also urging parents to make sure their children get chickenpox vaccines and flu shot, as a strep A infection can be a complication of both viruses. Group A strep infections had been going down since 1995, when the chickenpox vaccine became available, Wiener says.
Some children might need to flu shots this year, and it's not too late in the season to get them, TODAY.com previously reported.
In addition to getting vaccinated, to prevent strep A infections, the CDC recommends washing your hands often for at least 20 seconds or using an alcohol-based hand sanitizer, especially after coughing or sneezing and before preparing food or eating. You should also cover your coughs and sneezes with a tissue and dispose of it right away. If you don't have a tissue, use your upper sleeve or elbow and not your hands.
When in doubt about your child's condition, seek medical care. Even if it turns out it wasn't necessary, “it’s better than having a bad outcome,” Wiener says.
This story first appeared on TODAY.com. More from TODAY:
