Strep infections have remained at high levels so far this spring, even compared to pre-pandemic years.
The Centers for Disease Control and Prevention said unpublished data from its national surveillance program showed that emergency department visits for routine strep infections reached a five-year high in February and March. .
A report from Epic Research, which analyzes electronic health records, suggests that in February, strep throat rates were nearly 30% higher than the previous peak in February 2017.
Preliminary data suggests the upward trend continued in March, the group told NBC News.
The CDC could not confirm Epic’s statistics because it does not have data on routine strep infections since 2017.
But Dr. Michael Cappello, vice chair of pediatrics for Advocate Children’s Hospital in the Chicago area, said that compared to pre-pandemic levels, “we’re actually seeing more run-of-the-mill strep throats, without doubts.”
Strep rates are usually highest from December to April, but doctors last year started seeing cases in September.
Rates of invasive group A strep infection are also higher than usual. Unlike ordinary strep, invasive cases are severe and sometimes life-threatening; they occur when bacteria spread to parts of the body that are normally germ-free, such as the bloodstream, lungs, joints or bones.
A CDC spokeswoman said Wednesday that “many states continue to see higher-than-usual numbers of invasive group A strep cases, particularly among children ages 17 and younger and adults who 65 years old and above.”
The CDC has issued a health alert in December about an increase in pediatric cases of invasive group A strep infections.
An ‘unprecedented’ rise in invasive strep A
Dr. Maureen Ahmann, a pediatrician at Cleveland Clinic Children’s, said her practice has seen a significant increase in invasive strep A cases.
“It’s still rare compared to all the other childhood diseases, but we’re seeing a tumor,” Ahmann said.
The United States recorded several million cases of noninvasive group A strep each year, but about 14,000 to 25,000 invasive infections, according to the CDC. Between 1,500 and 2,300 people die of invasive cases each year.
Dr. Sam Dominguez, an infectious disease specialist at Children’s Hospital Colorado and a professor at the University of Colorado School of Medicine, said his hospital saw about 80 cases of invasive strep from October to March. In contrast, there were about five to 10 cases annually during the pandemic years and about 20 each year before that, he said.
“We’ve actually seen an unprecedented increase in group A strep — more than we’ve probably seen here, looking back, for at least a decade, and probably longer than that,” Dominguez said.
Invasive strep can trigger skin infections like flesh-eating disease, lower airway infections like pneumonia, or streptococcal toxic shock syndrome, an immune reaction that can lead to organ failure. The CDC has recorded 117 cases of streptococcal toxic shock syndrome so far this year, compared to a total of 45 last year.
Why didn’t the strep cases go down?
Epic Research’s findings, which have not been peer-reviewed, are based on visits to doctors’ offices and emergency rooms at more than 1,100 hospitals and 24,900 clinics in the US, as well as a health organization in Lebanon, if where the group also collects data.
According to the report, strep throat is most common among children ages 4 to 13, but all age groups have seen an increase.
Doctors have several theories as to why strep infections have remained at such a high level.
One is that cases dropped during the pandemic due to Covid mitigation measures, which made people more susceptible later. The second possible reason is the respiratory virus surge the US saw this winter. Cappello said viral infections can weaken people’s immune systems or irritate the protective lining of the nose, mouth and throat, making it easier to get strep.
“The other possibility is, maybe it’s a different strain of group A strep that we haven’t seen yet,” Cappello said.
But doctors are hopeful that the cases will soon decrease. Dominguez and Cappello said their hospitals have seen fewer cases of invasive strep so far in April than in previous months.
“I hope that means we’re in a downswing,” Cappello said.
Antibiotic shortages are a challenge
The high rate of strep infection was made more difficult by the lack of the antibiotic amoxicillin. The Food and Drug Administration reported a shortage of a powdered version of the drug in October, which has not yet been resolved.
Ahmann said some parents in Ohio are struggling to fill their children’s liquid amoxicillin prescriptions.
“It got to the point a month ago, if we needed liquid amoxicillin, we’d actually print out the script and give it to the parent and say, ‘Listen, last I heard, so-and-so down the street has this , but if not, try here,'” Ahmann said. “Parents literally go from pharmacy to pharmacy looking for someone who has it.”
But he added that, anecdotally, the shortage finally seems to be shrinking.
Doctors recommend that children get tested for strep if they have a red or sore throat that makes swallowing painful, fever, swollen lymph nodes or rashes.
“If your child suddenly doesn’t communicate with you, it’s hard to arouse, incoherent, it’s really hard to breathe, things like that, that’s really a trip to go to the emergency room immediately,” Cappello said.
Originally published
