• Posted December 20, 2022

Rising Cases of Invasive Strep A in Kids Have Experts Concerned

The U.S. Centers for Disease Control and Prevention is looking into a possible increase in invasive group A strep bacterial infections among children in the United States.

A number of children's hospitals in different parts of the country have reported seeing more dangerous strep A infections in recent weeks, leading federal officials to launch an investigation.

The agency noted the investigation for invasive group A strep on its website, and warned that a national shortage of the liquid antibiotic amoxicillin could complicate efforts to treat the infections.

However, experts say group A strep responds to many available antibiotics.

"This is still relatively rare, and so this is not a cause for panic at this point in time,"said Dr. Samuel Dominguez, an infectious disease specialist at Children's Hospital Colorado, which has seen an uptick in cases. "I don't think it's something to be too worried about, but parents should definitely be aware this is happening so that if they see any worrisome signs, they bring their kids in for medical attention as soon as possible."

The U.S. cases follow a wave of invasive group A strep cases in the United Kingdom that have killed at least 15 children since mid-September, according to the U.K. Health Security Agency.

"I think the CDC is now looking into it a little more closely to sort of get a sense of how widespread this is within the United States, but multiple children's hospitals are now reporting that they're seeing this,"Dominguez continued.

Group A strep infections typically result in a sore throat, well-known as "strep throat."They also can cause scarlet fever (a fever combined with a red rash) and impetigo (red sores with yellow scabs).

"About 10% to 20% of school-age children can be colonized with the group A strep bacteria in their throats at any point in time,"Dominguez said. "This is a very ubiquitous, very common bacteria that causes a lot of common infections in children that pediatricians and family practice doctors see all the time and treat pretty regularly."

When to worry

But in rare instances, a group A strep infection can become dangerous when the bacteria invades other parts of the body.

"This strep gets out of the throat and gets into the bloodstream and perhaps in other organs,"said Dr. William Schaffner, medical director of the Bethesda, Md.-based National Foundation for Infectious Diseases. "Those are very serious sepsis infections that can be life-threatening."

Serious illnesses that can result from invasive group A strep include:

• Dangerous airway infections like pneumonia or emphysema
• Skin infections like necrotizing fasciitis, better known as "flesh-eating disease"
• Streptococcal toxic shock syndrome, in which blood pressure drops and organs fail as a result of severe infection of the deep tissues and bloodstream

Anyone can develop an invasive group A strep infection, but children and seniors are more prone to developing a serious illness from their infection, Dominguez said.

Children's hospitals in Arizona, Colorado, Texas and Washington have reported higher-than-average numbers of cases this year compared to past years, NBC News reported.

But it's not happening in all parts of the United States.

Children's Hospital of Philadelphia and Children's National in Washington, D.C., have not seen any significant uptick in group A strep infections at this time, spokespeople for the two hospitals said.

"Some locations think that they have seen it. They're busy counting their infections now to try to confirm that. And other places have looked and said, no, we're pretty flat,"Schaffner said. "We're a big, diverse country, of course, and we wouldn't expect this to happen uniformly across the country."

There are a few potential explanations for why invasive group A strep is on the rise in parts of the United States.

Group A strep bacteria likely are one of the bugs that are more freely circulating with the waning of pandemic-prompted infection prevention strategies like masking and social distancing, Dominguez said.

In fact, experts are still trying to figure out if there's a true increase in invasive group A strep cases, or if these cases are simply returning to their pre-pandemic levels, Schaffner said.

The huge wave of influenza, RSV (respiratory syncytial virus) and COVID-19 that's sweeping the country also could be playing a role, by making kids more vulnerable to a dangerous group A strep infection, the experts said.

Group A strep is an opportunistic bacterium that can take root and flourish in a body that's been weakened by another illness like influenza or RSV, Dominguez and Schaffner explained.

"We do know that certain viral respiratory infections can predispose you to having a more serious bacterial infection -- either bacterial co-infection, meaning you have the virus and the bacteria at the same time, or a super infection where you have a virus and then eventually you get a bacteria because you had a virus in your body at one point in time,"Dominguez added.

There's also the possibility that a new and more infectious strain of group A strep is spreading, Dominguez said.

"They've done a little looking into that in Europe and, so far, at least in Europe, the data suggests that maybe that's not the case,"Dominguez noted. "I still think we need more data, and more local data here in the United States, to really answer that question."

Antibiotics work 'brilliantly'

The good news is that antibiotics can quickly and easily clear up group A strep, Schaffner said.

"Once it gets into the bloodstream you'd have to treat it just as quickly as possible, but the antibiotics we have work brilliantly against group A strep,"Schaffner said.

The CDC says the shortage of the liquid antibiotic amoxicillin -- which it says is most often prescribed to treat group A strep infections -- is anticipated to last several months.

But group A strep can be killed by many other antibiotics, even those as basic as simple penicillin, Dominguez said.

Concerned parents should keep an eye out for children who have a high fever, appear very sick, are having trouble breathing, aren't eating, are becoming dehydrated or are acting lethargic, Schaffner and Dominguez said.

"A preceding sore throat is not necessary, but if it's there, bring that to your provider's attention,"Schaffner said.

There's no vaccine to protect against group A strep, but vaccination against flu and COVID-19 can ward off a viral infection that would leave a child more vulnerable to the bacteria, Dominguez said.

"Another vaccine that we have that's very important to mention is the chickenpox vaccine,"Dominguez added. "We do know that once you have a chickenpox infection, that can predispose you to getting a severe group A strep skin infection."

More information

The U.S. Centers for Disease Control and Prevention has more about invasive group A strep.

SOURCES: Samuel Dominguez, MD, infectious disease specialist, Children's Hospital Colorado, Aurora; William Schaffner, MD, medical director, National Foundation for Infectious Diseases, Bethesda, Md.