Invasive Group Strep A Still An Acute Threat In CA, CDC Warns

CALIFORNIA — Cases of invasive group A strep infections are still making people sick in California and several other places around the country, public health officials warned.

The Centers for Disease Control and Prevention said its preliminary 2023 data shows group A strep infections are occurring at rates above those seen before the pandemic.

The bacteria is commonly carried by people in their noses and throats or on the skin, but in its invasive form, it can invade parts of the body that are normally free from germs. This more severe type of strep is usually seen in children, but the CDC said some areas of the country are seeing it more often in adults, including those 65 and older.

Officials with the California Department of Public Health are advising people to see their doctor and get tested if they have symptoms such as fever and sore throat.

"While strep throat caused by Group A Streptococcus is usually a mild illness, it can rarely be associated with complications like rheumatic fever or more severe streptococcal infections," said CDPH spokesman Ronal Owens. "Symptoms of strep throat include sudden onset of sore throat, pain with swallowing, and fever. Persons with symptoms of strep throat should consult their healthcare provider to see if they should get tested."

Like other contagious illnesses, invasive group Strep A cases dropped during the social distancing of the pandemic, falling to the lowest number of cases on record since 1997 among school-aged kids.

Mild and moderate strep infections are usually treated with amoxicillin, which is in short supply. Alternative therapies are available. Invasive group Strep A roared back last year amid the shortage of drugs to treat it, although there’s no data link as yet between those developments, the CDC said.

In California, doctors aren't required to report strep throat infections to state health officials, so it's hard to no know just how much Stret throat is circulating in the Golden State. However, an uptick is being seen across several school districts and doctor's offices around the state.

Dr. Afif El-Hasan, who's with the American Lung Association and a pediatrician with Kaiser Permanente in Orange County, told NPR he thinks the pandemic may be playing a role in the increase in group A strep infections. Additionally, it can be tricky distinguishing between Strep throat and other respiratory illnesses slamming California this year, he said.

"Well, strep throat actually makes up about 20 to 30% of sore throats in children, five to 15% of sore throats in adults. And what most patients feel is the classic sore throat with a fever. But you can also get nausea, vomiting, stomach aches and even a rash," told NPR. Sometimes it's very difficult to tell unless we actually do testing. I become more suspicious that it might be strep throat if someone comes in with a sore throat, a fever and does not have a runny nose or cough, doesn't have red eyes that you would see with a virus. And it's just the standalone symptoms of just sore throat, fever, maybe with some stomach pain and nausea. Then I become much more suspicious for strep throat. But the truth is, even with the other viral symptoms, it is also possible that there could be an accompanying strep throat with viruses."

There has been no shortage of other viruses circulating this cold and flu season.

"The fact that we are seeing a prevalence of viruses together that everyone's heard over. Everyone's heard - you know, flu is here. We have COVID, of course," he said. "That's been lingering for quite a while, as well as other respiratory viruses. And those viruses actually do weaken the body's natural defenses and does make it easier for a bacteria like strep to cause an infection."

A week after the CDC’s December warning of an uptick in cases, the World Health Organization reported invasive Group A infections were also increasing in several other countries.

Invasive group strep A is both dangerous and rare, with anywhere between 14,000 and 25,000 illnesses a year in the United States. The fatality rate is around 1,500 to 2,300 people a year, according to the CDC.

Any strep A case warrants a trip to the doctor. Typical symptoms include fever, sore throat and difficulty swallowing.

Parents and caregivers should also keep an eye out for symptoms of toxic shock syndrome — fever, chills, muscle aches, nausea and vomiting — and the so-called “flesh-eating” disease, necrotizing fasciitis — a fast-sreading swollen area on the skin, severe pain and fever, along with blisters, changes in skin color or pus at the infected area.