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Sore throats and sour news.
A recent study from the Centers for Disease Control and Prevention found that the number of potentially life-threatening invasive group A strep infections more than doubled from 2013 to 2022.
Most group A strep infections cause mild illnesses like strep throat — but when that bacteria spreads to the blood and deep tissue, it can trigger streptococcal toxic shock syndrome (STSS), a lethal bacterial infection that kills 30% of patients.
In advanced stages, STSS can cause necrotizing fasciitis — that is, flesh-eating disease — and even organ failure. Patients are typically prescribed antibiotics to treat the infection, but in severe cases, affected tissue and even entire limbs must be removed.
Published in the Journal of the American Medical Association, the study revealed that cases of invasive group A Streptococcus (GAS) increased from 3.6 to 8.2 cases per 100,000 persons.
Looking at only 10 states, the study identified more than 21,000 total cases of invasive group A infection over the nine-year period, including nearly 2,000 deaths.
“When you see this high number of deaths, extrapolate that across the country — we’re probably well into more than 10,000 deaths,” Dr. Victor Nizet, a professor of pediatrics at the University of California, San Diego, told NBC News.
Before 2013, rates of invasive strep had remained stable for 17 years.
Who’s at risk — and why are rates rising?
The latest study found that infection was particularly high among those 65 years or older, American Indian or Alaska Native people, residents of long-term care facilities, people experiencing homelessness, and IV drug users.
The threat of invasive strep to both high-risk groups and the general population has “substantially increased,” the authors notes.
They believe this is due to several factors, including rising rates of diabetes and obesity, both of which compromise the immune system and make patients more vulnerable to invasive strep and skin infections.
Invasive strep is also on the rise among those who use intravenous drugs, which allows the bacteria to enter the bloodstream.
Increases in popularity of IV fentanyl use could also explain the acceleration because of frequent injections and needle sharing. These behaviors are believed to contribute to the higher infection rate in homeless populations.
The spike is “particularly alarming” and “illuminates the extent to which invasive GAS thrives in settings of social disadvantage and marginalization,” said Theresa Lamagni, MSc, PhD, of the United Kingdom Health Security Agency in an accompanying editorial.
Further, researchers believe strains of group A strep are expanding and diversifying, and that these new strains are more likely to cause skin rather than throat infections.
These same strains may increasingly resist antibiotic treatments, specifically macrolides and clindamycin. While penicillin is the standard protocol for strep treatment, it is often combined with clindamycin when the infection advances to STSS.
Are kids at risk?
Interestingly, the study did not note an uptick in infection rates among children despite a CDC alert and widespread reports of pediatric cases of invasive strep in 2022.
“That was, to me, the most shocking part of the study,” Dr. Allison Eckard, division chief for pediatric infectious diseases at the Medical University of South Carolina, told NBC News.
“Because clinically, we are seeing what feels like an increase. We are just seeing more severe cases, more unusual cases, more necrotizing fasciitis, and cases that do raise concern that something is going on more nationally.”
She added that more research is needed to discern whether certain strep strains are becoming more virulent or prevalent.
Is a strep vaccine on the way?
The surge in cases and the devastating toll have researchers calling for the development of a strep vaccine, especially in light of increasing evidence of antibiotic resistance.
“It’s one of those pathogens that causes a pandemic in plain sight, and because we haven’t succeeded in controlling it, we look elsewhere for easier targets, but this is one of those hard targets that I think really need to commit to dealing with,” said Joshua Osowicki, MBBS, PhD, a pediatric infectious diseases physician at Royal Children’s Hospital Melbourne and co-author of the accompanying editorial.
