Group A Strep – Is It Something I Need to Worry About?

What is going on with Strep A? The incidence of group A Streptococcus (GAS) is higher than usual. What illnesses are caused by GAS? What is “invasive” GAS? How do I know if my child is seriously ill and needs medical care?

Key takeaways:
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    Group A streptococcus (GAS) infections are higher than would be expected, and occurring earlier than usual this winter.
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    The GAS bacteria can colonize without symptoms or cause strep throat, ear infections, and upper respiratory infections.
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    Rarely the bacteria can infect deeper tissues in the bones, joints and lungs causing invasive GAS.
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    GAS is treatable with antibiotics (typically amoxicillin or penicillin).
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    Key symptoms to look for are sore throat, strawberry red tone, and sandpaper rash.

Group A Streptococcus (GAS) is a bacteria that can cause minor skin infections, strep throat, ear infections (acute otitis media or AOM), sinus infections, and rheumatic heart disease. The bacteria can also live harmlessly – colonize – in the mouth and throat without causing symptoms. People who have GAS but no symptoms are considered “carriers.”

How common is strep throat?

Although most sore throats are caused by viruses, 5-15% of adults and 20-30% of children have a positive GAS test. This means that viruses cause most sore throats. Children between the ages of three and nine have the highest case GAS rates, followed by adolescents ages 10 through 19 and infants younger than two years.

How is it spread?

Strep is contagious and spread by respiratory droplets and direct contact. You can become exposed by breathing in droplets, touching something with droplets on it, then touching your mouth or nose, or sharing glasses or utensils with a person infected by GAS. The incubation period between exposure and the onset of symptoms is two to five days.

What are the typical symptoms?

Strep throat is typically not seen with a cough or runny nose. Most often, the sore throat sets in very quickly and is painful when swallowing. A fever is common, as are red and swollen tonsils, which may also have white patches or streaks of pus. Other symptoms include swollen lymph nodes in the front of the neck and tiny red spots on the roof of the mouth. Young children may also have headaches, stomach pain, nausea, or vomiting.

What is scarlet fever?

The GAS bacteria sometimes release toxins that can cause a rash covering the body with tiny raised red bumps (like sandpaper). This is called scarlet fever. Your doctor can do a quick strep test and prescribe antibiotics for scarlet fever.

Can antibiotics treat the infection?

Antibiotics – typically penicillin or amoxicillin – are prescribed for GAS infection to shorten the illness duration, limit transmission, and prevent complications. However, even those without a positive GAS test may be given antibiotics – up to 72% of adults and 56% of children with pharyngitis (sore throat) receive antibiotics. Pharyngitis, AOM, and sinusitis are the three most common conditions for which antibiotics are prescribed during an outpatient clinic or emergency department visit in the US.

What is invasive Group A Strep and how prevalent is it?

The CDC is investigating if invasive GAS is increasing. Invasive GAS is when the bacteria infects the bones, joints, lungs, or bloodstream. These serious infections can (but rarely) cause necrotizing fasciitis (“flesh-eating disease”) or streptococcal toxic shock syndrome. Symptoms can include a fever and red, warm, or swollen areas of skin that spread quickly, accompanied by severe pain extending beyond the area of red or swollen skin. It is important to act quickly after an injury or surgery if you notice these symptoms. Antibiotic treatment is given intravenously, but it is rare to spread this type of infection, so close contacts are usually not prescribed antibiotics.

Is there a vaccine for Group A Strep?

Not yet. A 30-valent (strain) vaccine is currently in development. However, immunity to GAS is thought to be built with time over repeated exposures.

Are there any vaccines available right now to protect against bacterial infections?

Yes, two routine pediatric vaccines are available. Streptococcus pneumonia (pneumococcus) can cause pneumonia, sinusitis, meningitis, and AOM as well as bacteremia (a blood infection). The CDC recommends that all children younger than five years and older adults at higher risk for serious illness receive one of the four pneumococcal vaccines available (PCV13, PCV15, PCV20, and PPSV23). Another vaccine prevents Haemophilus influenza type b (Hib). Before vaccines for Hib, about 20,000 children became seriously ill and 1,000 died. More than half of these cases were among babies younger than one year.

What should parents do about GAS?

There are many viruses and bacteria currently in circulation, and even out of season. Influenza (flu) and respiratory syncytial virus (RSV) started earlier in the fall and winter than usual, but there are signs that these viruses may have peaked in some areas of the country. Children must develop immunity to these pathogens, and often, their illness will resolve without treatment. However, given that co-infection (bacterial infection on top of a viral illness) can cause complications, it is important to keep an eye out for worsening symptoms and seek help when appropriate. The CDC encourages parents to learn about necrotizing fasciitis and streptococcal toxic shock syndrome and seek help quickly if their child has one of these infections. Getting a flu shot and making sure your child is up to date on chickenpox vaccination (first dose at 12 to 15 months of age and the second dose at four to six years of age) can also help reduce the risk of invasive GAS infection.

Seek urgent help now if your child has the following symptoms:- Pale, abnormally cold to touch- Blue lips- Cannot talk or eat/drink- Fits or seizures- Extremely agitated, confused, difficult to wake- Dark green vomit- Rash that does not disappear. Contact a doctor or nurse today if your child has these symptoms:- Hard to breathe- Unable to swallow- Rash like scarlet fever- A sore throat plus a sandpaper rash and red tongue - Not being able to drink or eat, not passing urine in 12 hours - Drowsy, irritable, unable to settle with toys, TV food or picking up- Shivering or muscle pain - Getting worse or worried.


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