Increase in Invasive Group A Strep Infections, 2022–2023

CDC is looking into an increase in invasive group A strep (iGAS) infections in children in the United States.

During the COVID-19 pandemic, the United States had very low numbers of iGAS infections in children. This was likely due to the steps many people took during the pandemic to prevent the spread of respiratory diseases (e.g., school and workplace closures, masking, physical distancing). Based on preliminary 2022 data, iGAS infections in children have returned to levels similar to those seen in pre-pandemic years.

Preliminary 2022 data also indicate that iGAS infection levels in children

  • Increased earlier in the season (September through November) than in a typical year (December through April)
  • Occurred over a similar time period as increases in respiratory viruses (e.g., influenza, respiratory syncytial virus [RSV]) and less severe GAS infections (e.g., strep throat)
  • Varied greatly between different areas in the country, as has been seen in past years
Group A strep bacteria can cause a range of illnesses

Invasive disease means that germs invade parts of the body that are normally free from germs. When this happens, disease is usually very severe, requiring care in a hospital and even causing death in some cases. Necrotizing fasciitis and streptococcal toxic shock syndrome are examples of iGAS infections.

In addition to causing uncommon but severe and invasive infections, group A strep bacteria cause common and generally mild illnesses like strep throat.

Parents and other family members should
Healthcare providers should
  • Offer prompt vaccination against influenza and varicella to all eligible persons who are not up to date
  • Consider iGAS as a possible cause of severe illness, including in children and adults with concomitant viral respiratory infections. Illness due to iGAS in persons with known viral infections may manifest as persistent or worsening symptoms following initial improvement
  • Educate patients, especially those at increased risk, 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 potential alternative agents for treating confirmed GAS pharyngitis in children due to the shortage of amoxicillin suspension
  • Notify appropriate local or state public health departments as soon as possible about unusually aggressive or severe iGAS cases affecting children younger than 18 years of age or clusters of iGAS infections in persons of any age
  • Ask laboratories to hold iGAS isolates or send them to the state public health laboratory for temporary storage
Amoxicillin Shortage

There is a national shortage of the liquid antibiotic (amoxicillin suspension) most often prescribed to children to treat group A strep infections. The shortage is anticipated to last several months.

Clinicians: View the American Academy of Pediatrics guidance for alternative therapies during the shortage.

Parents: If your child’s doctor prescribes and you are unable to find liquid amoxicillin in your area, talk with the doctor about other antibiotic options.

State and Territorial Health Departments should