Increase in Pediatric Invasive Group A Streptococcal Infections
The Centers for Disease Control and Prevention (CDC) issued a Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. The rates of iGAS infections are increasing above cases reported during the COVID pandemic time period. Although the overall number of cases has remained relatively low and iGAS infections remain rare in children,the CDC is investigating these reports and issued a health advisory to raise awareness.
Group A Streptococcus (GAS) bacteria can cause a range of illnesses, from pharyngitis (i.e., strep throat) and skin and soft tissue infections to uncommon but severe diseases such as sepsis, streptococcal toxic shock syndrome, and necrotizing fasciitis. These severe and invasive diseases are associated with high mortality rates and require immediate treatment, including appropriate antibiotic therapy. Increased rates of iGAS infection have been noted during times of increased influenza activity. Seasonal influenza activity is currently high in the US and above the
levels seen in recent years.
Groups at higher risk for iGAS include:
- People with concurrent or preceding viral infections
- People aged 65 years or older
- American Indian and Alaska Native populations
- Residents of long-term care facilities
- People with medical conditions such as diabetes, malignancy, immunosuppression, chronic kidney, cardiac, or respiratory disease
- People with wounds or skin disease
- People who inject drugs or who are experiencing homelessness
Recommendations for Healthcare Providers
- Offer prompt vaccination against influenza and varicella to all eligible persons who are not up to date.
- Consider iGAS as a possible cause of severe illness, including in children and adults with concomitant viral respiratory infections.
- Educate patients, especially those at increased risk, on signs and symptoms of iGAS requiring urgent medical attention, especially
necrotizing fasciitis, cellulitis and toxic shock syndrome.
- Obtain culture for suspected iGAS infections, including blood, wound, and pleural fluid cultures, as clinically indicated.
- Follow clinical practice guidelines for diagnosis and treatment of GAS pharyngitis .
- Be mindful of potential alternative agents for treating confirmed GAS pharyngitis in children due to the shortage of amoxicillin
- Notify appropriate local or state public health departments as soon as possible about unusually aggressive or severe iGAS cases
affecting children younger than 18 years of age or clusters of iGAS infections in persons of any age.
- Ask laboratories to hold iGAS isolates or send them to the state public health laboratory for temporary storage.
For more information, please consult the complete CDC Health Advisory .