At least two children in the U.S. and 15 in the U.K. have died from infections with strep A, a bacteria that normally causes mild disease but can be extremely dangerous when it invades tissues outside of where it normally resides.
Hospitals in several states — Arizona, Colorado, Texas and Washington — have told NBC News that they are seeing higher numbers of invasive Group A streptococcus than is typical. In Colorado, the invasive disease has led to the deaths of two children since November. The last strep A deaths in the state were in 2018.
The increasing reports of invasive disease have spurred the Centers for Disease Control and Prevention mount an investigation.
Each year, several million Americans contract Group A strep, but only a small fraction — 14,000 to 25,000 — develop invasive disease with 1,200 to 2,500 dying from it. Most at risk are children and older adults.
This year, one hospital in Texas has already seen a four-fold rise in cases of invasive Group A strep, NBC News reported. Since Nov. 1, the Denver Health Department has reported 11 cases — much higher than its typical rate of about one to two a month. All 11 kids were between 10 months and 6 years old. The two children who died were too young to go to school.
What is invasive strep A?
Strep A refers to the diseases that come from being infected with the bacteria called Group A streptococcus. It usually causes a sore throat, aka strep throat, “a mild and common condition that can be easily treated,” according to the Colorado Department of Public Health and Environment. Another common condition due to a strep A infection is cellulitis, which causes redness, swelling and pain in the infected area of the skin, per the CDC.
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.
Other conditions that can result from a strep A infection include:
- Scarlet fever, which commonly causes rash and fever.
- Necrotizing fasciitis, popularly known as flesh-eating disease.
- Rheumatic fever, which can inflame or make the heart, joints, brain and skin swell.
- Streptococcal toxic shock syndrome (STSS), “which can develop very quickly into low blood pressure, multiple organ failure, and even death,” per the CDC.
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.”
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
- 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.