Strep A Linked To 2 U.S. Pediatric Deaths: What MD Parents Should Know

MARYLAND — Public health officials are monitoring a rare, invasive form of the usually mild and common bacteria known as group A strep that has been linked to at least two U.S. pediatric deaths. The development comes as the antibiotic to treat the infection is in short supply.

The Centers for Disease Control and Prevention is investigating a possible increase in invasive group strep A infections, which killed between 1,500 and 2,300 people a year in the last five years, the agency said.

Group A streptococcus bacteria, or iGAS, is highly contagious and commonly carried by people in the nose, throat and skin. It usually causes a sore throat and can be treated with the liquid antibiotic amoxicillin suspension; however, a shortage of this drug is expected to last for several months. Alternative therapies are available.

In its invasive form, strep A can enter the bloodstream, lungs, spinal cord and other places inside the body where the bacteria typically would not live, leading to diseases such as pneumonia, endocarditis (an infection of the heart’s inner lining), meningitis, urinary tract infections, sepsis, the serious skin and tissue infection necrotizing fasciitis, and streptococcal toxic shock syndrome, which causes low blood pressure and injury to organs such as the kidneys, liver and lungs.

The Maryland Department of Health and Mental Hygiene and the Baltimore County Department of Health in September investigated a cluster of three severe invasive Group A Streptococcus infections in people who recently had liposuction at a cosmetic surgery center, Monarch Med Spa in Timonium. The procedures occurred in mid-August to mid-September. All three patients were hospitalized; one subsequently died, according to the health department.

Parents whose children show invasive group A strep symptoms should contact their physicians, the CDC said. Those symptoms include:

• A fever 100.4 degrees Fahrenheit or higher;
• Severe muscle aches;
• Progressive dizziness, weakness and confusion;
• Localized muscle tenderness; and
• Redness at the site of a wound.

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,” Dr. William Schaffner, medical director of the Bethesda, Maryland-based National Foundation for Infectious Diseases, told U.S. News. “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

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.

There is no vaccine for group A strep, but keeping children current on vaccines for the flu, COVID-19 and chickenpox can help protect them against severe illnesses, Colorado state epidemiologist Dr. Rachel Herlihty said in a news release.

The California Department of Public Health said parents should make sure their children are up to date on their varicella (chickenpox) and influenza (flu) vaccinations, as occasionally, group A strep infections occur following viral infections such as chickenpox and influenza.

"The CDC is also advising parents and caregivers to learn about the symptoms of the severe infections associated with iGAS, such as severe skin infections (aka “flesh-eating” infection) and toxic shock syndrome," California public health officials said. "Parents should seek medical care quickly if they, their children, or other family members think that they may have one of these infections."

In Colorado, there have been 11 reported cases of invasive group strep A in children since Nov. 1. in the Denver metro area in children 10 months to 6 years old. The Colorado Department of Public Health and Environment said it was aware of two deaths among these cases. Both were young children who were not yet school-aged. The state had not seen a pediatric death due to group A strep since 2018.

Minnesota health officials also issued an invasive group A strep advisory, saying the number of cases reported so far in November (46)was more than double the number in other months this year.

Infections are increasing in Europe, too, with health officials in Great Britain saying Thursday that strep A infections are linked to the deaths of 74 people, including 16 children.

The World Health Organization said Thursday that increases in invasive group A strep diseases have also been reported in France, Ireland, the Netherlands and Sweden, mostly among children under 10.

Health officials aren’t sure what is causing the increase in invasive A strep infections. CDC spokesperson Kate Grusich said in an email to CNN that the agency hasn’t determined if group A strep infections are returning to normal pre-pandemic levels or if something else is at work.

“The recent increases in respiratory viruses, particularly influenza, may also be contributing to a possible increase in iGAS infections,” Grusich said. “Concurrent or preceding viral infections such as influenza and skin conditions such as chickenpox may increase risk for iGAS infections.”