Increase in invasive group A strep infections
The CDC has been looking into increases in invasive group A strep (iGAS) infections in the US.
Invasive disease means that germs invade parts of the body that are normally free from germs. When this happens, the disease is usually very severe, requiring care in a hospital and even causing death in some cases. Necrotizing fasciitis and streptococcal toxic shock syndrome are examples of iGAS infections.
In addition to causing uncommon but severe and invasive infections, group A strep bacteria cause common and generally mild illnesses like strep throat.
Why is Strep A spreading so rapidly right now?
One explanation could be that a recent spike in respiratory virus infections has left people more susceptible to infection with group A streptococcus.
At least five European countries have reported an increase in invasive group A streptococcus (iGAS) infections in recent months, and in some cases, scarlet fever.
The CDC estimates, 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 1,500 and 2,300 people die annually due to invasive group A strep disease. Invasive group A strep disease can include:
- Cellulitis, with blood infection
- Necrotizing fasciitis
- Streptococcal toxic shock syndrome (STSS)
While some group A strep infections cause invasive diseases, experts estimate that several million cases of non-invasive group A strep illnesses occur each year. Non-invasive group A strep diseases include:
- Pharyngitis (strep throat), which causes an estimated 5.2 million outpatient visits and 2.8 million antibiotic prescriptions annually among US persons aged 0–64 years.
- Scarlet fever
Complications of these group A strep infections, like post-streptococcal glomerulonephritis and acute rheumatic fever, are rare.
CDC does not track non-invasive group A strep infections, however, they do track 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.
Through ABCs, the CDC tracks data on group A strep isolate resistance to select antibiotics. Currently, iGAS is not resistant to penicillin and amoxicillin, first-line antibiotics for strep throat. Nearly 1 in 4 invasive iGAS infections now are caused by erythromycin- and clindamycin-resistant strains, limiting the patient’s treatment options.
Group A strep infections can occur any time during the year. However, some infections are more common in the United States in certain seasons:
- Strep throat and scarlet fever are more common in the winter and spring.
- Impetigo is more common in the summer.
Anyone can get a group A strep infection, but some infections are more common in certain age groups:
- Strep throat and scarlet fever are most common in children between the ages of 5 and 15 years.
- Impetigo is most common in children between the ages of 2 and 5 years.
Learn to look for the warning signs
Strep throat is a bacterial infection with symptoms that differ from a viral sore throat. Understanding the difference between a sore throat and strep throat can help you determine your next steps for treatment.
Adults and Parents:
- Learn about the symptoms for necrotizing fasciitis, streptococcal toxic shock syndrome, and cellulitis.
- Seek medical care quickly if they think they or their child has one of these infections.
- Make sure everyone in the household is up to date with flu and chickenpox vaccines, since getting these infections can increase risk for getting an iGAS infection.
Healthcare providers are offering prompt vaccination against influenza and varicella to all eligible persons who are not up to date. Physicians are considering iGAS as a possible cause of severe illness, including in children and adults with concomitant viral respiratory infections. Illness due to iGAS in persons with known viral infections may manifest as persistent or worsening symptoms following initial improvement.
It’s important to educate patients, especially those at increased risk, on signs and symptoms of iGAS requiring urgent medical attention especially necrotizing fasciitis, cellulitis, and toxic shock syndrome.
Your healthcare provider may obtain a culture for suspected iGAS infections, including blood, wound, and pleural fluid cultures, as clinically needed. Follow CDC’s recommendations for preventing invasive group A streptococcal disease among household contacts of case-patients and postpartum and post-surgical patients
There is a national shortage of the liquid antibiotic (amoxicillin suspension) most often prescribed to children to treat group A strep infections. As of January The shortage is anticipated to last several months.
Note for Adults/Parents: If your doctor prescribes you or a loved one Amoxicillin and you are unable to find liquid Amoxicillin in your area, talk with the doctor about other Antibiotic options.
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