Key points
- Preliminary 2023 data indicate the number of serious infections caused by group A Streptococcus (group A strep) reached a 20-year high.
- Currently, less serious infections are also at high levels throughout the country, as is typically seen from December through April.
- People, including healthcare providers and public health professionals, can take protective actions.
Overview
Overall, the number of serious group A strep infections has been increasing in the United States over the past decade. The increase has been seen primarily in adults.
Concerning trend returned post-pandemic
During the COVID-19 pandemic, these serious infections decreased by up to 25% compared to the years right before the pandemic. They were especially low in children during the pandemic.
In fall 2022, serious group A strep infections increased to levels higher than those seen in pre-pandemic years, particularly for children.
Visualize these trends
Serious infections remained high in 2023
Preliminary data indicate serious group A strep infections
- Remained high through April 2023
- Declined during the summer
- Then increased again in the fall
While group A strep bacteria circulate year-round, they're more common in December through April. Therefore, the timing of this increase was earlier than normal and similar to when increases were seen during 2022.
The increases in fall 2023 were more notable in adults, particularly in those aged 65 years or older. This differed from 2022 when the increase in numbers was greatest in children.
According to preliminary data, overall numbers of invasive group A strep infections in 2023 will exceed 2022 numbers.
Trends for less serious disease
Prior to the COVID-19 pandemic, less serious group A strep infections (e.g., strep throat, scarlet fever) were common. Numbers typically peaked each year during winter and spring months.
There were low numbers of these infections in all age groups during the pandemic. This was likely due to the steps many people took during the pandemic to prevent the spread of respiratory diseases.
Since then, they have returned to levels similar to or higher than those seen in pre-pandemic years. Currently, these minor infections are at high levels throughout the country, as is typically seen for this time of year.
Actions to take
To protect yourself and loved ones
- Learn about the symptoms for different group A strep infections
- See a healthcare provider for any concerning symptoms
- Learn about risk factors for serious infections
- Make sure everyone's up to date with flu and chickenpox vaccines
See a healthcare provider right away if you have symptoms of a serious group A strep infection, such as:
For healthcare providers
Consider invasive group A strep as a possible cause of severe illness. Obtain the following, as clinically indicated, for culture when invasive group A strep infection is suspected:
- Blood
- Wound
- Pleural fluid
Healthcare providers should also
- Offer vaccination to anyone eligible who's not up to date
- Tell patients about the signs and symptoms to watch for
- This is especially important for those at increased risk
- Follow clinical practice guidelines for group A strep pharyngitis
- Be mindful of the shortage of amoxicillin suspension
For public health professionals
Health departments should
- Investigate clusters of invasive group A strep infections
- Investigate potentially preventable infections
- Postpartum infections
- Post-surgical infections
- Follow CDC's prevention recommendations for
- Household contacts
- Postpartum patients
- Post-surgical patients
- Quickly investigate infections among long-term care facility residents
Resources
Investigation tools available
CDC has developed a toolkit for investigating and controlling group A strep outbreaks in long-term care facilities. These investigations are important given the increased risk for disease and death among this vulnerable population.
Decision Tool for Investigating Group A Streptococcus Infections in Long-Term Care Facilities
Amoxicillin shortage
There's an ongoing national shortage of some formulations of amoxicillin suspension. This is the liquid antibiotic most often prescribed to children to treat group A strep infections.
Clinicians: View the American Academy of Pediatrics guidance for alternative therapies during the shortage.
Parents: If you aren't able to find liquid amoxicillin in your area, talk with the prescribing healthcare provider about other options.