Invasive Group A Strep Infections Rising Among Children

Well, it’s official. The U.S. has a GAS issue, where GAS stands for Group A Streptococcus or Group A Strep. The Centers for Disease Control and Prevention (CDC) has confirmed that there has indeed been a rise in the number invasive group A streptococcal (iGAS) infections among children. Now, you may have already heard about possible increases in such infections in different states. For example, on December 15, the Colorado Department of Public Health and Environment reported on 11 cases since November 1, 2022, in the Denver metropolitan area with two deaths among these cases. But “possible” ain’t the same as a “hey, let’s alert everyone about this” situation, which is what the CDC did in issuing a Health Alert Network (HAN) Health Advisory on December 22.

So, add this rise in such bacterial infections to the rises in respiratory virus infections such as Covid-19, the flu, and respiratory syncytial virus (RSV) infections that the U.S. has been facing, and the Winter of 2022-2023 has become quite a cough, cough affair. iGAS infections are caused by not surprisingly Group A Streptococcus bacteria. It’s actually quite common to have GAS—GAS bacterial infections, that is. Group A strep can cause a variety of common skin and soft tissue infections. And most likely you’ve heard of strep throat, which is a pharyngitis or inflammation of the throat caused by GAS bacteria. This typically isn’t a deep throat problem because a course of oral antibiotics can usually clear the infection when taking in a timely manner.

iGAS infections are a different story. Although they usually are much rarer, much bigger problems can arise when the bacteria gets more invasive. In this case, invasive doesn’t mean that the bacteria asks you a bunch of very personal questions such as how many partners have you had and why do you have handcuffs in the closet. Rather, it means that the bacteria gets deeper inside your body causing bad things such as sepsis, streptococcal toxic shock syndrome, and necrotizing fasciitis. All of these things can be quite life threatening.

Sepsis is when the infection spreads to your bloodstream and prompts a rather extreme reaction from your immune system and body. It can result in change in your mental status, severe drops in your blood pressure, very rapid breathing, and eventually organ failure. Having sepsis is not a positive thing. When sepsis proceeds to septic shock, mortality can jump to around 40%.

Toxic shock syndrome may sound like the name of a punk rock band but is when toxins secreted by bacteria lead to a variety of systemic problems in your body. This can include fever, lethargy, confusion, rash, skin peeling, drops in blood pressure, and damage to different organs. Clearly anything with the words “toxic” and “shock” are not good things, unless you are saying something like “I’m shocked that you are not as toxic as I had thought.”

Necrotizing fasciitis is a severe form of skin and soft tissue infection. If your date calls you necrotizing, then that doesn’t bode well for a second date. Necrotizing means causing necrosis, which is the death of living tissue. Therefore, necrotizing fasciitis is when pieces of your skin and underlying tissue begin to die and potentially slough off your body. That clearly is not a positive thing either.

Yep, all of these possibilities ain’t good. Therefore, when you or your child has a GAS infection, you certainly should stay vigilant about any signs that things are getting more invasive. Stay aware of any indication that the bacteria is spreading beyond the throat or the initial portion of the skin affected. Contact your doctor if the antibiotics do not seem to be improving symptoms within two to three days.

Vigilance does not mean panic, though. It also doesn’t mean flapping your arms above you and yelling, “It’s just like the Covid-19 pandemic! It’s just like the Covid-19 pandemic!” It isn’t. Before you drop everything and start hoarding toilet paper again, keep in mind that the CDC did indicate that the overall number of these more severe invasive cases among children has “remained relatively low.” Therefore, if you or your child has a GAS infection, chances are it won’t progress to iGAS as long as you get proper treatment in a timely manner. Nevertheless, any rise in such severe, albeit very rare, illnesses does deserve monitoring from the CDC, other public health authorities, health care systems, and health care professionals. Hence the CDC alert.

It’s not completely surprising that iGAS infections among children have been on the rise. Over the years prior to the Covid-19 pandemic, cases of GAS infections in the U.S. have tended to follow a seasonal pattern, rising during the Winter months, peaking in December through April, and subsiding during the late Spring and Summer. Over the past two Winters, GAS infections have actually been lower than normal, probably due to people taking Covid-19 precautions. Such precautions could have directly prevented the transmission of GAS, which occurs via direct contact, respiratory droplets, or contaminated objects and is typically highest among school-aged children from five to 15 years of age.

Additionally, such precautions could have indirectly decreased GAS infection by decreasing the activity of viruses such as influenza. In the past, iGAS infections have tended to go up when flu activity has been high. An influenza infection can make you more prone to get bacteria infections because your immune system is busy fighting the virus.

So what do you do to prevent a GAS infection, which could potentially progress to iGAS? Here are several things:

• Wash your hands frequently and thoroughly. If you already haven’t figured out that good hand hygiene is important after the past three years, then please don’t touch anyone else’s food ever.
• Regularly clean and disinfect high-touch surfaces. Similarly, this is a practice that you should have down pat by now.
• Get up-to-date on all recommended vaccinations. This includes getting the influenza, varicella (chickenpox), and Covid-19 vaccines. Having the flu or chicken pox can increase you risk for an iGAS infection.
• Keep your wounds clean and properly covered. You probably won’t run into too many people who’ll tell you that open and dirty wounds are sexy. Plus, wounds and other things that cause cracks and openings in your skin can essentially create a revolving door for bacteria.
• Don’t come into close contact with someone who has GAS, meaning a GAS infection. This can be easy to remember if you just keep repeating, “Stay away from anyone with any kind of gas.”
• Maintain Covid-19 precautions. Again, it’s probably no coincidence that iGAS infections dropped the past two Winters when many more folks were wearing face masks while in public indoors and practicing more social distancing.

Most of the recently reported iGAS cases have been in kids ranging in age from 10 months to 6 years. But remember the Group A Streptococcus bacteria, like most such pathogens, doesn’t discriminate by age. The bacteria won’t say, “You’re too old for me,” and avoid infecting you if you are beyond a certain age range. In fact, those over 65 years of age are at greater risk for an iGAS. Those who live long-term care facilities, have chronic medical conditions such as diabetes, heart disease, lung disease, kidney disease, or cancer, inject drugs, or are experiencing homelessness are at higher risk as well.

Again, this new CDC warning doesn’t mean that you should panic. It’s not the same as the Covid-19 pandemic. Just try to maintain the aforementioned precautions. And if you or your child does get a GAS infection, get the proper antibiotic treatment as soon as you can. Meanwhile, be on the lookout for any signs that the GAS infection may be getting worse and becoming invasive. After all, you don’t want to add “i” to the GAS problem that you are having.