Surveillance

CDC estimates, in the most recent five years, approximately 14,000 to 25,000 cases of invasive group A strep disease occur each year in the United States. In the last five years between 1,500 and 2,300 people die annually due to invasive group A strep disease. Invasive group A strep disease can include:

• Cellulitis with blood infection
• Necrotizing fasciitis
• Pneumonia
• Streptococcal toxic shock syndrome (STSS)

In contrast, experts estimate that several million cases of non-invasive group A strep illnesses occur each year. Non-invasive group A strep diseases include:

• Pharyngitis (strep throat), which causes an estimated 5.2 million outpatient visits and 2.8 million antibiotic prescriptions annually among US persons aged 0–64 years¹
• Scarlet fever
• Impetigo

Complications of these group A strep infections, like post-streptococcal glomerulonephritis and acute rheumatic fever, are rare.

Globally, the burden from group A strep infections is even greater. For example, the World Health Organization estimates:

• 111 million children in the developing world have impetigo²
• 470,000 new cases of acute rheumatic fever occur each year²
• 282,000 new cases of rheumatic heart disease occur each year²

In 2015, there was an estimated 33.4 million cases of rheumatic heart disease.³

Bact Facts Interactive

Analyze and visualize ABCs group A strep data using Bact Facts Interactive.

Surveillance systems

CDC does not track non-invasive group A strep infections.

CDC tracks invasive group A strep infections through Active Bacterial Core surveillance (ABCs), a population-based, active- and laboratory-based surveillance system. This means local and state health departments routinely contact laboratories to identify all cases, then report those cases to CDC.

Currently, the only nationally reported group A strep disease is STSS. Healthcare providers and laboratories should report cases to the appropriate health department. States then report these cases to CDC through the National Notifiable Diseases Surveillance System (NNDSS).

Antibiotic resistance

Through ABCs, CDC tracks data on group A strep isolate resistance to select antibiotics. Currently, GAS is not resistant to penicillin and amoxicillin, first-line antibiotics for strep throat. Nearly 1 in 4 invasive GAS infections now are caused by erythromycin- and clindamycin-resistant strains, limiting the patient’s treatment options.

Disease trends

Group A strep infections can occur any time during the year. However, some infections are more common in the United States in certain seasons:

• Strep throat and scarlet fever are more common in the winter and spring.
• Impetigo is more common in the summer.

Anyone can get a group A strep infection, but some infections are more common in certain age groups:

• Strep throat and scarlet fever are most common in children between the ages of 5 and 15 years.
• Impetigo is most common in children between the ages of 2 and 5 years.

References

1. Lewnard JA, King LM, Fleming-Dutra KE, Link-Gelles R, Van Beneden CA. Incidence of pharyngitis, sinusitis, acute otitis media, and outpatient antibiotic prescribing preventable by vaccination against group A Streptococcus in the United States. Clin Infect Dis. 2021;73(1):e47–e58.
2. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685–94.
3. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990-2015. N Engl J Med. 2017;377(8):713-722.