The U.S. Centers for Disease Control and Prevention announced this month that they are investigating a potential rise of a bacterial infection in children called invasive Group A Strep (iGAS).
The CDC says this type of infection can be associated with rarer symptoms including necrotizing fasciitis and streptococcal toxic shock syndrome.
At least 11 cases have been reported in Colorado since November of this year. Two deaths among these cases have been reported, but officially iGAS has not yet been ruled as the cause of death.
The news comes after the United Kingdom Health Security Agency (UKHSA) released a statement warning caregivers about an uptick in cases of illnesses related to the bacteria Streptococcus A, also known as Group A Strep (GAS).
The agency reported a significant uptick in cases of iGAS.
These cases of iGAS, while still rare, have also been linked to 15 deaths in children under the age of 18 according to UK data.
We spoke to experts about the potential risks of this disease spreading widely in North America and how parents can recognize symptoms.
What is invasive group A strep?
iGAS is a bacteria that can cause the disease strep throat, which can be common in children.
The bacteria can also cause more severe disease including scarlet fever, which results in rash and fever, along with impetigo, which results in a sores.
Dr. Jessica Madden, a board-certified pediatrician and neonatologist who also works as the medical director for Aeroflow Breastpumps alongside her own practice, says that one of the challenges with this spike in Strep A infections, particularly strep throat, is that symptoms of other conditions can mask its presence.
Additionally, children may have multiple diseases at the same time with similar symptoms.
“I think what’s very confusing about this fall and early winter with Strep A definitely circulating through the pediatric population, and also so many different upper respiratory viral illnesses is we have a lot of children who have both at the same time,” Madden said. “They have influenza A, but they also have strep throat, or they have Rhinovirus or RSV with strep throat and sometimes the strep throat can get missed because a lot of these other viral illnesses going around can cause a very very sore throat with enlarged lymph nodes.”
Another challenge for healthcare workers is that, unlike the UK’s National Health Service (NHS), the US system reports on these conditions differently.
According to pediatric infectious disease expert and researcher Dr. Anthony Flores (MD, PhD) of the University of Texas Health and Houston’s Memorial Hermann Children’s Hospital, that makes tracking more concerning conditions like scarlet fever difficult.
“Historically, and this has been done through the Centers for Disease Control and Prevention, and so they have what’s called the Active Bacterial Core Surveillance that monitors invasive disease,” Flores said. “Typically, what they’re most interested in is what we call invasive disease. And that’s when these bacteria get into normally sterile sites, get into the bloodstream, get into bones and joints and things like that. Scarlet fever is not classically considered an invasive disease and so that hasn’t been followed.”
When it comes to iGAS, however, the CDC puts the number of cases in the last five years as being between 14,000 and 25,000 in the USTrusted Source. The average number of deaths have been between 1,500 and 2,300 people annually, according to the CDC.
Dr. Christina Johns, a pediatric emergency physician and senior medical advisor to PM Pediatric Care in Annapolis, Maryland, says the severity of a patient’s condition can change quickly when it comes to Group A Strep, especially in children.
“The tricky part of these … rarer cases of Invasive Group A Strep is that children can become very sick very quickly,” Johns said. “Oftentimes it’s a kind of situation where children will go, in terms of their illness severity, from zero to 60 very, very quickly and so any rapid deterioration in condition always warrants attention.”
Symptoms of scarlet fever and iGAS
- Scarlet fever has a distinctive rash, often described as like sandpaper.
- iGAS is linked with a very high fever and can cause the potentially deadly condition of sepsis.
- Impetigo often includes what Dr. Johns calls a “honey-colored crust” on the skin.
- Experts say if your child has symptoms and doesn’t appear to be as alert or responsive as normal, head to an ER immediately.
Why have cases spiked?
The UKHSA identified the last spike as being in 2017-2018 and attributes this year’s outbreak in part to an increase in socializing.
Flores says that these spikes are coming at times of the year when they wouldn’t typically be seen. Instead of spikes occurring in April and May, they appear to be happening in November and December. He attributes these increased rates, similar to the vast amount of RSV cases he’s seeing in the pediatric system, to a combination of a previous lack of exposure and an increase in masking over the last couple of years.
“Close contact with other individuals really promotes that transmission and so masking was incredibly effective at stopping that. And now that we’re not masking as much, and we’re in closer proximity, I think that we’re seeing higher transmission rates than what we’ve seen in the past couple of years.”
Prevention and treatment
The most common treatment for iGAS is a prescription of the antibiotic amoxicillin. While the common antibiotic is in short supply in some areas of the country, Johns says that there is little reason to panic as there are other options available.
“I think that this is the kind of situation that can really get spun up into really scary hype very quickly. ‘Oh my word, this is the bacteria that causes strep throat, my child has had strep throat, does this mean my child is now going to die?’ And I think it is important to point out that Group A strep is seen all the time, definitely in the pediatric setting.”
In terms of prevention, the bacteria is highly contagious and so needs to be treated via antibiotics. If the infection is showing signs in the skin, like cracking, it’s important to have those areas covered to also reduce the risk of transmission.
