Physicians are prepping for invasive group A strep cases following an increase among children last season.
Rising pediatric strep cases caused more young children than usual in 2022 to contract a severe group A strep infection. Young children’s immune systems are still developing, and therefore they can be at a higher risk for developing a severe infection from strep.
Streptococcal bacteria causes common and generally mild illnesses such as strep throat and scarlet fever. However, if left untreated, group A strep (iGAS) can progress and become invasive throughout the body. According to the Centers for Disease Control and Prevention (CDC), in the past five years, approximately 14,000 to 25,000 cases of invasive group A Strep have occurred annually, and 1,500 to 2,300 people die each year due to invasive group A strep disease. Severe iGAS infections may lead to life-threatening diseases including pneumonia, necrotizing fasciitis, and streptococcal toxic shock syndrome.
Respiratory illness cases overall decreased during the COVID-19 pandemic. According to the CDC, group A strep cases during the pandemic decreased by nearly 25% in the U.S., with invasive group A strep numbers remaining especially low among children. Recently though, hospitals throughout America and Europe have been experiencing more iGAS cases in children than is typical. According to the Colorado Department of Public Health and Environment, since the 2022 respiratory season, there have been 11 reported cases of invasive group A strep in children, and two children died from the disease.
Dangers of group A strep in children
Physicians are preparing for a busy upcoming respiratory season, as group A strep cases have been on the rise along with other illnesses including RSV, COVID-19, and the flu.
Disease mitigation efforts implemented during the pandemic, such as school and workplace closures, masking, and social distancing may have contributed to lowered respiratory illnesses in previous years. However, now that the nation has been returning to pre-pandemic normalcy, preliminary CDC data indicates that iGAS infection levels in children are increasing earlier in the season than in a typical year. Group A strep cases were higher than pre-pandemic levels in some areas of the country such as Colorado and Minnesota.
According to a CDC study titled “Increase in Pediatric Invasive Group A Streptococcus Infections in Colorado and Minnesota,” most cases (73.5%) that occurred during the recent increase in October through December 2022 were in children and adolescents without underlying medical conditions, which has raised concerns among health professionals.
“At Children’s Hospital of Colorado, we hypothesize several different reasons for the increased number of group A invasive strep cases. The first and likely contributing factor is that an increase in cases came on the heels of our large respiratory viral surge that we had in 2022 and 2023, and our data supports that there is an association between the rise in RSV and flu cases, as well as a subsequent rise in invasive group A strep cases,” according to Dr. Sam Dominguez, infectious disease specialist at Children’s Hospital Colorado and professor at University of Colorado School of Medicine.
Strep is dangerous particularly for young children, because if the disease is left untreated, it can lead to more invasive infections that a child’s developing immune system has difficulty fighting off.
“Invasive group A strep can present in multiple different ways. With our experience at Children’s Hospital of Colorado in the past six to eight months, parents should pay attention to if children are having trouble breathing or walking, if they are progressively getting worse, and if they have a rapidly spreading rash. These symptoms are indicators of a secondary bacterial infection, and you should bring your child into the hospital quickly,” said Dr. Dominguez.
Prevention of invasive group A strep infection
Health systems are preparing to deal with an increase in severe strep cases in respiratory seasons going forward. During respiratory season, parents should ensure children are washing hands, staying away from people that are sick, and that children are up to date with vaccinations.
“Respiratory viruses are a risk factor for more invasive disease. We strongly encourage everyone in the upcoming flu season to get their influenza vaccine, variella vaccine, and the COVID-19 vaccine. Getting your vaccines is critically important for prevention of all the respiratory infections they’re targeted against, and they have the benefit of decreasing risk of a secondary bacterial infection as well,” according to Dr. Dominguez.
Parents should monitor children for signs of strep infection including fever, sore throat, trouble swallowing, or children not acting like themselves. Children should see a physician for mild to more severe strep symptoms so that doctors can prescribe antibiotics to clear the infection. There is currently a national shortage of amoxicillin suspension, the liquid antibiotic often prescribed to children to treat group A Strep infection. The American Academy of Pediatrics recommends that children instead take amoxicillin tablets, capsules, or chew tabs, or discuss with a doctor about alternate antibiotic options to treat the infection. Children should take all antibiotics prescribed, even if they start to feel better.
“The most common symptom we think of with group A strep is pharyngitis (sore throat). If your child has a high fever, sore throat, and headache, without accompanying respiratory symptoms, see your primary care provider for medical attention to be treated with antibiotics and to make sure your child doesn’t have group A strep,” said Dr. Dominguez.