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CDC provides guidance to clinicians as pediatric invasive group A streptococcal infections rise

December 22, 2022

Health officials are providing guidance to clinicians to combat an increase in pediatric invasive group A streptococcal (iGAS) infections.

While case counts were low during the early part of the COVID-19 pandemic, they have been rising over the past few months, according to a health advisory issued Thursday by the Centers for Disease Control and Prevention (CDC). It is unclear if the increase is above pre-COVID seasonal patterns. Increased iGAS cases also have been reported in France, Ireland, the Netherlands, Sweden and the United Kingdom, most of which are affecting children under 10 years, according to the World Health Organization.

Group A Streptococcus bacteria is spread primarily by the respiratory route. Infections typically are most prominent in December through April and when flu activity is high, as it is now. GAS can cause pharyngitis (strep throat) and skin and soft tissue infections, according to the CDC. It also can cause severe invasive diseases such as sepsis, streptococcal toxic shock syndrome and necrotizing fasciitis.

People at increased risk for iGAS include those with concurrent or preceding viral infections like flu or varicella, people 65 and older, American Indian and Alaska Native populations, residents of long-term care facilities, people with certain underlying medical conditions, people with wounds or skin disease, people who inject drugs and people experiencing homelessness.

The CDC provided the following recommendations for health care providers:

  • Vaccinate eligible patients against influenza and varicella.
  • Consider iGAS as a possible cause of severe illness in children and adults with concomitant viral respiratory infections.
  • Educate patients 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 AAP recommendations for alternative antibiotics for treating GAS pharyngitis in children during the amoxicillin suspension shortage.
  • Notify local or state public health departments as soon as possible about unusually aggressive or severe iGAS cases in children or clusters of iGAS infections in people of any age.
  • Ask laboratories to hold iGAS isolates or send them to the state public health laboratory for temporary storage.

The CDC is encouraging the public to learn about the symptoms of necrotizing fasciitis, streptococcal toxic shock syndrome and cellulitis, and seek care quickly if they think they or any family members may have one of these infections. Everyone is encouraged to stay up to date on flu and varicella vaccines.



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