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Current Group A Strep Activity

Key Points
  • Preliminary 2023 data indicate the number of severe infections caused by group A Streptococcus (group A strep) reached a 20-year high.
  • Currently, less severe 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.


Group A strep bacteria cause a range of infections.

Some, called invasive group A strep infections, aren’t common but they are severe and life-threatening. Others, referred to below as non-invasive group A strep infections, are more common and generally milder.

Invasive disease trends

Increasing trend returns post-pandemic

Overall, the number of invasive group A strep infections has been increasing in the United States over the past decade, primarily in adults.

During the COVID-19 pandemic, these infections decreased by up to 25% compared to the years right before the pandemic. These severe infections were especially low in children during the pandemic. In fall 2022 invasive GAS infections increased to levels higher than those seen in pre-pandemic years, particularly for children.

Visualize these trends

In 2020 and 2021, invasive group A strep cases and deaths were lower than they had been since 2016.  However, in 2022, those numbers rebounded to the highest level on record since 1997.

Infections remained high in 2023

Preliminary data indicate invasive group A strep infections remained high through April 2023, declined during the summer, and 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.

Some people are at increased risk

Viral infections, like flu or chickenpox, can increase the risk for getting an invasive group A strep infection.

Medical conditions that can increase the risk for getting an invasive group A strep infection include:

  • Cancer
  • Chronic heart, kidney, or lung disease
  • Diabetes
  • Immunocompromising condition (having a weakened immune system)
  • Wounds or skin disease

Other groups at increased risk for getting an invasive group A strep include:

  • American Indian and Alaska Native populations
  • People aged 65 years or older
  • People who inject drugs or who are experiencing homelessness
  • Residents of long-term care facilities

Non-invasive disease trends

Prior to the COVID-19 pandemic, less severe 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, non-invasive group A strep infections have returned to levels similar to or higher than those seen in pre-pandemic years. Currently, these infections are at high levels throughout the country, as is typically seen for this time of year.

Tips for protecting yourself and loved ones

Parents and other family members should

When to seek immediate medical attention

See a healthcare provider right away if you have symptoms of an invasive group A strep infection, such as:

Key steps 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 influenza and varicella vaccination to anyone eligible who’s not up to date
  • Educate patients, especially those at increased risk, on signs and symptoms to watch for
  • Follow clinical practice guidelines for group A strep pharyngitis
  • Be mindful of the shortage of amoxicillin suspension

Recommendations for public health professionals

State and territorial health departments should

  • Investigate clusters of invasive group A strep infections
  • Investigate potentially preventable infections (e.g., postpartum and post-surgical infections)
  • Follow CDC’s prevention recommendations for household contacts and postpartum and post-surgical patients
  • Urgently investigate group A strep infections among residents of long-term care facilities
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.

Amoxicillin Shortage

There’s an ongoing national shortage of some formulations of the liquid antibiotic (amoxicillin suspension) 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 antibiotic options.