What is Strep A and the invasive infection it can cause?

Strep A refers to the Group A streptococcus bacteria. Cases are often mild, but serious infections can come from the invasive Group A strep, known as iGAS, according to the UKHSA. IGAS is rare, but can be life-threatening. It occurs when bacteria goes deeper into the body, infecting the lungs, muscles and bloodstream. “Whilst iGAS infections are still uncommon, there has been an increase in cases this year, particularly in children under 10 and sadly, a small number of deaths,” the UKHSA said in a statement .

What are the symptoms of Strep A?

Strep A symptoms are often flu-like and mainly include “strep throat” — generally, a mild infection but one that can be painful. It usually takes two to five days for someone exposed to the bacteria to become ill, according to the Centers for Disease Control and Prevention . Other symptoms may include fever, headache, swollen lymph nodes in the front of the neck, nausea and skin infections such as pus-filled blisters or inflammation, according to Britain’s National Health Service . By contrast, a cough, runny nose, hoarseness in the throat and conjunctivitis (also known as pinkeye) normally suggest a viral infection and not Strep A, the CDC says . Most people with Strep A recover without any complications, it said. Getting strep throat does not protect someone from contracting it again. The far rarer iGAS infections, however, sometimes seen in children with concurrent viral infections, can get into their bloodstream and deep tissue, causing more severe illnesses such as blood infections, endocarditis (an infection of the heart’s inner lining), meningitis, urinary tract infections, streptococcal toxic shock syndrome, which causes low blood pressure and injury to organs such as the kidneys, liver and lungs, necrotizing fasciitis and scarlet fever.

How is Strep A transmitted?

Streptococcal bacteria is spread through coughing, kissing, sneezing and touching, from someone with an infection or a carrier, according to the NHS. Outbreaks are more frequent in facilities like schools and care homes where close contact is common, it said. Occasionally, the bacteria can also enter the body through food contaminated with it. Invasive streptococcal infections are more likely to be picked up by people with existing health conditions “that reduce immunity to infection,” including cancer, diabetes, kidney disease and those who take certain medications such as steroids, the NHS says.

Why are children badly impacted?

“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.” Children are also likely more exposed to Strep A at schools and other similar places, he added. Simon Clarke, associate professor in cellular microbiology at Britain’s University of Reading, agreed that children tend to have less developed immunity and therefore could be more prone to the infection. The coronavirus pandemic might be a factor in the uptick of cases. “It may be the case that because of social distancing and lockdown, we’ve been exposed less to these sorts of bugs, and therefore there is less immunity in the general population and they transmit more frequently,” he said. The World Health Organization said this month that the increase in iGAS cases among children could also be “associated with the recent increased circulation of respiratory viruses, including seasonal influenza and respiratory syncytial virus, as coinfection … may increase the risk of iGAS disease.” Cases of Strep A are “higher than expected” in the U.K. compared with previous years, according to the British government, with the UKHSA saying that investigations are underway into the increase in children under 10. “It isn’t possible to say for certain what is causing higher than usual rates of these infections,” the agency said . “Currently, there is no evidence that a new strain is circulating.”

Is there a Strep A vaccine?

There is no Strep A vaccine available. Most cases are treated with a course of antibiotics. Rapid tests and throat cultures, which involve swabbing, are most commonly used to diagnose Strep A, according to the CDC. Antibiotics should decrease the symptoms and prevent the bacteria from spreading to others, it said, making those infected “start feeling better in just a day or two” after beginning the drug. Streptococcal infections can also sometimes be diagnosed by a blood or urine test, and invasive forms may need intravenous antibiotics, the NHS said. “Early treatment improves the outlook greatly,” it added. “Strep A is theoretically vaccine-preventable, and there are large efforts ongoing to help develop vaccines,” said Marks, who is running studies on transmission of Strep A and immunity in Gambia, with a view to supporting development of vaccines. “In the long term, this strategy will hopefully reduce the risk of infection and death causes by Strep A worldwide.”

How can you or your child avoid getting Strep A?

Parents should look out for the symptoms above in their children and contact a health professional for advice if their child is very sick, not eating, dehydrated or has a dry diaper for over 12 hours. “As a parent, if you feel that your child seems seriously unwell, you should trust your own judgment,” Britain’s government advised . To prevent contracting the bacteria, the NHS suggests “good hand washing,” especially after coughing and sneezing, before preparing foods and before eating. Cuts and other wounds should also be kept clean and watched for signs of infection. Teaching your child how to wash their hands properly with soap and warm water for 20 seconds, using a tissue to catch coughs and sneezes, are also useful to limit the spread of infections. Putting used tissues in the trash, using alcohol-based hand sanitizer and washing plates and utensils of sick people are other measures that can be taken, the CDC said. Most cases of Strep A infections normally resolve if caught early and are “treatable,” Clarke said.

Strep A: What to know about the usually mild infection tied to at least two U.S. pediatric deaths

In Britain, 74 people, including 16 children, have also died from it.

By Jennifer Hassan

Adela Suliman

and

Ariana Eunjung Cha

Updated December 23, 2022 at 10:06 a.m. EST|Published December 6, 2022 at 9:46 a.m. EST

Streptococcus pyogenes. (BSIP SA/Alamy Stock Photo)

A rare, invasive form of a usually mild and common bacterial infection has killed several children in the United States and Europe in recent weeks, according to public health authorities, prompting alarm among parents and vulnerable adults.

Get the full experience.Choose your plan

Two children have died in the United States due to the Group A streptococcus bacteria, also known as Strep A, according to the Colorado Department of Health. In Britain, a total of 74 people, including 16 children, have also died of the invasive infection this season, the U.K. Health Security Agency (UKHSA) said on Thursday.

Strep A is highly contagious and commonly carried by many people in the nose, throat and skin without resulting in serious illness, medical officials and experts say. Most cases are not life-threatening, but can develop into infections known as invasive Group A strep (iGAS), which can be fatal, with the risk greatest among children and the elderly.

The Centers for Disease Control and Prevention alerted doctors and public health authorities on Dec. 22 to be on the lookout for cases involving invasive Group A strep infections and to diagnosis and treat them promptly.

Brian Spencer, a spokesman for the Colorado Department of Public Health and Environment, said the two deaths in that state were in “young children who were not school-aged” from the Denver area.

Spencer said severe group A strep infections can occur as a complication of RSV, flu, covid-19 or other common respiratory illnesses and urged parents to seek help if their child’s respiratory infection worsened. The state had not seen a pediatric death due to group A strep since 2018, he said.

“Early treatment is critical to keeping initial group A strep infections mild and from progressing to the more serious illnesses it can cause,” he said.

The World Health Organization said earlier in December that France, Ireland, the Netherlands and Sweden have also observed increases in invasive group A streptococcus disease, as well as scarlet fever, including an unspecified number of deaths in France and Ireland. Most of those affected are children under age 10.

The WHO said the risk to the general population is low for the time being, describing the rising case counts as “moderate,” and noting that neither antibiotic resistance, nor new variants have been observed. However, the agency said, “[t]he risk will be continuously assessed based on available and shared information.”

Here’s what you need to know.