'Unprecedented' uptick in invasive group A strep infections

May 16, 2023
three bumpy purple lines intersect.
More than a dozen children at the MUSC Shawn Jenkins Children's Hospital have been diagnosed with invasive group A strep infections since December.

The national increase in invasive group A strep infections in children, under investigation by the Centers for Disease Control and Prevention, is borne out by the numbers at the MUSC Shawn Jenkins Children’s Hospital.

“To see more than 12 since December is very, very unusual,” said Allison Eckard, M.D., division chief for pediatric infectious diseases. “This is unprecedented.”

Strep throat is a common childhood ailment often treated with antibiotics. It’s caused by group A strep bacteria. “In some cases, the bacteria may be present in children’s throats, and they don’t even require treatment. Occasionally, however, group A strep can cause very serious invasive infections,” Eckard said.

Group A strep is considered invasive when the bacteria infect an area that doesn’t normally have bacteria. “So, for example, your blood or your bone or your joint or your pleural space,” Eckard said. The pleural space is in the lung area.

Group A strep bacteria can enter the body through the respiratory tract, she said, or – and this may surprise some parents – through a break in the skin. The bacteria can be on the skin and take the opportunity to enter the body when a person gets what can be a minor cut. 

“Group A strep are bad bacteria. Certain strains can have virulence factors that make it more aggressive in some cases and in some patients. And, so, what could be routine strep throat in some kids or a knee scrape, in another case can overwhelm the body with infection and cause septic or toxic shock and, in some cases, unfortunately death.”

The CDC said invasive group A strep infections have also caused cases of necrotizing fasciitis. Necrotizing means it causes the death of tissues. Fasciitis refers to inflammation of tissue under the skin.

Dr. Allison Eckard 
Dr. Allison Eckard

“Most of the time, children who have group A strep pharyngitis are going to do just fine,” Eckard said, referring to strep throat. “But you have to have a healthy respect for the bacteria, as serious infections can develop and progress very rapidly. If your child is acting sicker than expected with the usual cold or sore throat or your child has any concerning signs or symptoms, it is better to seek medical attention early rather than waiting,” Eckard said.

Kids are more likely to get strep than adults. Strep throat is most common in kids age 5 to 15.

While invasive group A strep is rare, a person suffering from it can get very sick quickly. Early symptoms include a high fever; severe aches and pain; sore muscles; redness around a wound; dizziness; confusion; and a widespread, intense red rash.

The CDC said invasive strep A infections went down during the COVID-19 pandemic. They began to rise in 2022, and in 2023, they’ve stayed high in some parts of the country.

“It is possible that this uptick in cases is related to the fact that children were not exposed to group A strep as often during the pandemic and have lower levels of protective antibody. It could also be due to many children being exposed or re-exposed to the bacteria at the same time, and our normal numbers of invasive group A strep are clustered together over a shorter period of time,” Eckard said.

“Another hypothesis is that there is a post-COVID effect, where some patients have a suppressed immune system after being infected with the virus, making them more susceptible to other infections. Or is there a new strain of group A strep? We really don't know yet.”

MUSC Children’s Health is working with the South Carolina Department of Health and Environmental Control to track and analyze cases. DHEC recommends careful and regular hand washing and keeping cuts and scrapes clean and covered to avoid getting or passing on group A strep.

The agency said on its website that there is no increased risk to the general public.

Eckard agreed but said it’s important for parents to know what to watch out for. “People tend to not think of group A strep as serious. But it can be very serious. And there are certain strains that tend to cause more morbidity and potential mortality in any age group but particularly in children because they're often exposed to group A strep in the school environment."

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