PA Issues Warning As Strep A Linked To 2 U.S. Pediatric Deaths

PENNSYLVANIA — Pennsylvania officials sent out a formal warning to healthcare providers after a possible increase in strep A infections led to two pediatric deaths nationwide. Strep A infections killed between 1,500 and 2,300 people a year in the last five years, the agency said.

The health advisory requested that facilities with patients at high risk for severe disease be on alert and review the state's recommendations for the disease and related professional resources.

The Centers for Disease Control called it a "rare, invasive form" of the typically mild bacteria. The development comes as the antibiotic to treat the infection is in short supply.

"Consider obtaining culture for suspected invasive infection (iGAS), including cultures ofabscesses, other infected sites, and blood cultures as clinically indicated," the Pennsylvania Department of Healt added.

Healthcare facilities with any suspected cases in Pennsylvania are urged to contact their local health department and the Pennsylvania Department of Health at 1-877-724-3258, and also report cases to the electronic disease surveillance system, PA-NEDSS.

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.

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

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

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. In her state, there have been 11 reported cases of invasive group strep A in children since Nov. 1.

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 of 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.”

Those at greatest risk to severe group A strep infections are the very young and old, as well as people with existing health conditions that reduce immunity to infection, including cancer, diabetes, kidney disease and steroids, according to health officials. The bacteria is spread through coughing, sneezing, kissing and touching.

“Rates of iGAS are highest at extremes of age — in children and the elderly,” Michael Marks, an associate professor at the London School of Hygiene & Tropical Medicine, told The Washington Post. “This is not fully understood, but may reflect immunity.”