Strep infections have remained at high levels so far this spring, even compared to pre-pandemic years.
The Centers for Disease Control and Prevention said unpublished data from its national surveillance program shows emergency room visits for regular strep infections hit a five-year high in February and March.
A report by Epic Research, which analyzes electronic health records, suggests that February strep throat rates were almost 30% higher than during the previous peak in February 2017.
Preliminary data suggests the uptrend continued in March, the group told NBC News.
The CDC couldn’t confirm Epic’s stats because they don’t have regular data Streptococcal infections from 2017.
But dr Michael Cappello, vice chair of pediatrics at Advocate Children’s Hospital in the Chicago area, said that compared to before the pandemic, “we’re definitely seeing more common strep throat, without a doubt.”
Strep rates are usually highest from December to April, but doctors started seeing cases as early as September last year.
Group A invasive streptococcal infection rates were also higher than usual. Unlike common streptococci, invasive cases are serious and sometimes life-threatening; They occur when bacteria spread to normally germ-free areas of the body, such as the bloodstream, lungs, joints, or bones.
A CDC spokesman said Wednesday that “many states continue to see higher than usual numbers of invasive group A streptococcal cases, particularly among children ages 17 and younger and adults ages 65 and older.”
The CDC issued a health alert in December about the increase in pediatric cases of invasive group A streptococcal infections.
An ‘unprecedented’ rise in invasive streptococcal A
dr Maureen Ahmann, a pediatrician at the Cleveland Clinic Children’s, said her practice has seen a significant increase in invasive Strep A cases.
“It’s still rare compared to all other childhood illnesses, but we’re seeing a bump,” Ahmann said.
The US records several million cases of noninvasive group A streptococcus each year, but only about 14,000 to 25,000 invasive infections, according to the CDC. Between 1,500 and 2,300 people die each year from the invasive cases.
dr Sam Dominguez, an infectious disease specialist at Children’s Hospital of Colorado and a professor at the University of Colorado School of Medicine, said his hospital had about 80 cases of invasive streptococcal infection from October through March. In contrast, in pandemic years, there were about five to 10 cases a year, and before that about 20 a year, he said.
“We’ve really seen an unprecedented rise in group A streptococci — more than we’ve probably seen here in at least a decade and probably longer than that,” Dominguez said.
Invasive streptococci can trigger skin infections like flesh eating disease, lower respiratory tract infections like pneumonia, or streptococcal toxic shock syndrome, an immune response that can lead to organ failure. The CDC has registered 117 cases of streptococcal toxic shock syndrome so far this year, compared to a total of 45 last year.
Why haven’t strep cases gone down?
Epic Research’s findings, which were not peer-reviewed, are based on doctor’s office and emergency room visits at more than 1,100 hospitals and 24,900 clinics in the United States, as well as at a healthcare organization in Lebanon, where the group also collects data.
According to the report, strep throat was most common in children aged 4 to 13, but all age groups have seen an increase.
Doctors have some theories as to why strep infections persist at high levels.
One is that cases have fallen during the pandemic due to Covid mitigation measures, making people more vulnerable later on. A second possible factor is the surge in respiratory viruses that the US experienced this winter. Cappello said these viral infections can weaken people’s immune systems or irritate the protective lining of the nose, mouth and throat, making it easier for strep to develop.
“The other possibility is that maybe this is another strain of group A strep that we haven’t seen before,” Cappello said.
However, doctors are optimistic that cases will soon start to decline. Dominguez and Cappello said their hospitals had seen fewer cases of invasive streptococcal infection so far in April than in previous months.
“I’m confident that means we’re in a downturn,” Cappello said.
Antibiotic shortages are a challenge
The high rate of streptococcal infections was compounded by a shortage of the antibiotic amoxicillin. The Food and Drug Administration reported a shortage of a powder version of the drug in October that has not yet been resolved.
Ahmann said some Ohio parents are struggling to fill their children’s liquid amoxicillin prescriptions.
“It got to the point about a month ago when we needed liquid amoxicillin, we actually printed out the script and gave it to the parents and said, ‘Listen, last I heard so-and-so down the street had this , but if not, try here,'” Ahmann said. “Parents literally went from pharmacy to pharmacy looking for someone who had it.”
But she added that anecdotally, the shortage seems finally to be easing.
Doctors recommend getting children tested for strep if they have red or sore throats that make it painful to swallow, fever, swollen lymph nodes, or skin rashes.
“If your child suddenly stops communicating with you, is difficult to arouse, is incoherent, tries really hard to breathe, things like that, that’s definitely a trip to go to the ER immediately,” Cappello said.