番茄社区

During the height of the pandemic when people social distanced, wore masks, and remained out of school and work, invasive group A streptococcal infections were lower than usual.

However, late last year, the U.K. -- which has at times served as a harbinger of what's to come in the U.S. -- began reporting an , including more than two dozen deaths. Stateside, the CDC is also closely monitoring cases, which have so far trended up this season when compared with the last couple of years.

As infectious disease experts gather new insights, they're urging parents to be aware of certain symptoms in kids, and to not neglect their own health. But the verdict's still out on whether these infections are indeed a bigger problem this year than in years past.

William Schaffner, MD, professor of infectious diseases at Vanderbilt University Medical Center in Nashville, Tennessee, told 番茄社区 that there is "no doubt" that reports out of the U.K. are "an alert" for the infectious disease and public health communities in the U.S.

These reports "raised sensitivity and stimulated a lot of email communication around the country," he added, noting that there are several factors to consider when investigating the current state of group A strep infections.

Interventions put in place for COVID-19 had the "collateral benefit of reducing lots of other infections," he said. It's important to consider whether any increase in group A strep infections is a "resurgence to the previous, conventional level" or whether it is "above that."

"That question continues to be investigated," he noted.

At this point, it does not appear that recent group A strep infections are the consequence of a strep strain with new virulence attributes, Schaffner added. However, he pointed out that there has been a significant and early surge of influenza this season, and that group A strep infections "may have been, in part, facilitated by prior influenza infections."

Though many people carry group A strep in their throat without symptoms, he explained, an influenza infection and resulting inflammation of mucous membranes may, in certain cases, permit group A strep to evade normal protection and enter the bloodstream, causing sepsis.

Adam Ratner, MD, MPH, director of the division of pediatric infectious diseases at New York University Grossman School of Medicine and a member of the American Academy of Pediatrics Committee on Infectious Diseases, agreed that the prevalence of certain circulating viruses, including influenza, may be a contributing factor when it comes to group A strep infections.

"Having a viral infection can set you up for having a bacterial infection, particularly with flu," Ratner said.

That is also true of COVID and respiratory syncytial virus (RSV), he added, explaining that when someone has a viral infection, it can make it easier for bacteria normally present in the nose or throat to make it to other parts of the body where it shouldn't be.

As far as surveillance, it is important to determine whether there may be an increase in group A strep infections beyond normal levels in specific locations or more broadly nationwide, Schaffner said.

Indeed, the CDC is in the process of collecting data about recent infections.

"CDC is watching the data closely and talking with surveillance sites and hospitals in multiple states to learn more about any trends in group A strep infections they may be seeing," a spokesperson for the agency told 番茄社区 in an email. "We will share more information when it is available."

Just last month, the agency issued a to notify clinicians and public health authorities about the increase in pediatric invasive group A strep infections.

"Group A Streptococcus bacteria like strep throat, skin infections, and uncommon but severe infections such as sepsis, septic shock, streptococcal toxic shock syndrome, and necrotizing fasciitis," the CDC spokesperson added. "Invasive group A strep infections reported to CDC were lower than usual among all age groups during the COVID-19 pandemic. However, shows an increase in confirmed childhood [group A strep] infections between September and November 2022. This increase is above what CDC saw during the same period in 2020 and 2021, suggesting that case counts in children have returned to levels like those seen in pre-pandemic years."

At the same time, "it's too soon to say whether invasive group A strep case numbers are rising beyond what we would normally expect from group A strep seasonal patterns, pre-pandemic," the spokesperson continued. "The overall number of [invasive] cases is relatively low and [invasive] infections are rare."

CDC data show that numbered approximately 25,000 in and , and about 20,200 in .

The CDC spokesperson noted that immediate treatment with antibiotics, typically administered intravenously, is crucial for these infections.

"Strep throat also needs prompt antibiotic treatment to prevent serious complications and spread, often provided as liquid amoxicillin," the spokesperson added. "Given the current liquid amoxicillin shortage, CDC recommends that healthcare providers consider when treating children with strep throat, as advised by the American Academy of Pediatrics."

According to Ratner, available childhood vaccinations are also key. Though there is no vaccine for group A strep, it isn't too late for children and adults to get their influenza and COVID vaccines, he said.

As for what parents should look out for, Schaffner said that when it comes to early invasive sepsis, symptoms may be nonspecific, but do make a child look ill.

"All of a sudden, the child is lethargic, not eating, not as active and engaging," he explained. "Don't linger, bring that child to medical attention."

It's also important to note that invasive group A strep infections can affect adults as well, he said. "Moms and dads will bring young kids to their pediatrician," but may often put off seeking medical attention for themselves.

Overall, "invasive group A streptococcal disease is a serious disease -- untreated it can lead to an individual's death," Schaffner noted. However, when caught early, the "vast majority of these people are treated successfully and leave the hospital and continue to function in their daily lives successfully."

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