Eight children in the UK have died from a rare, invasive form of a common bacterial infection, according to health agencies, raising alarm among doctors and parents.
The bacteria, called group A streptococcus, are mostly known for causing strep throat.
These bacteria don’t always cause infections. In fact, they can live in your throat and on your skin without causing illness. But the bacteria can, in some people, develop into infections such as strep throat or tonsillitis. If untreated, they can go on to invade other parts of the body, such as the lungs or blood, which can cause serious and potentially life-threatening infections.
While many childhood illnesses, like colds and other upper respiratory infections, are caused by viruses and can't be treated with antibiotics, infections like strep throat need to be treated with them immediately.
These types of bacteria, if they grow unchecked, can cause scarlet fever, which causes a red, sandpaper-like rash, or rheumatic fever, which is an inflammation of blood vessels and joints that can permanently damage the heart.
Experts speculate that the current surge in respiratory viruses like the flu and RSV may be to blame for the rise in invasive strep A cases. Viral infections compromise your immune system, giving bacteria either in your environment or body the opportunity to take over, which is known as a secondary infection.
The latest update from the UK Health and Security Agency on Dec. 2 confirmed that since September, five children in England, all under 10 years old, died within a week of being diagnosed with invasive strep A.
A spokesperson for the agency told BuzzFeed News that two more children in England under age 15 have died. Another child in Wales has also died, the BBC reported.
The UK’s 2017–2018 winter season, the last with more strep A activity than usual, saw four deaths involving kids under age 10 in the same period. Most cases of invasive strep A are occurring in older adults, but 21% of infections so far have been in children ages 10 and under, which is higher than the range seen in the last five seasons.
There’s no evidence that a new strain of strep A is circulating at this time, UK health officials said.
Children in the UK are also coming down with scarlet fever at even higher rates than invasive strep A. No children have died from scarlet fever as of Dec. 7.
Is the US also experiencing increases in strep A infections?
During a call with reporters on Dec. 5, the CDC said that it has not “heard of any notable increase” in strep A cases in the US. But doctors, at least anecdotally, are noticing a growing number of secondary bacterial infections, some but not all of which are associated with strep A, according to Dr. Allison Bartlett, a pediatric infectious disease doctor and associate medical director of infection control at UChicago Medicine.
Bartlett told us that she and her colleagues are seeing many cases of secondary bacterial pneumonia, empyema (a collection of pus in a body cavity, usually the lungs), and sinusitis, including infections that spread into the eye or brain.
Still, it’s not really known whether there have been increases in strep A in the US.
The CDC does not track noninvasive strep A infections, but it does follow one invasive strep A disease: streptococcal toxic shock syndrome (STSS). The most recent data shows that one child died from invasive strep A in 2020, seven kids died in 2019, and six died in 2018.
The limited data means “we don’t actually know what the ‘normal’ number of [strep A] cases is” in the US, Bartlett said. “We usually see a peak of strep throat in the winter and early spring, but it’s not surprising that we are seeing it earlier this year like we are seeing for RSV and flu.”
Parents should be vigilant as the US deals with an amoxicillin shortage
Bartlett urges everyone, especially parents of young children, to remain vigilant of the signs of infection, particularly since there’s a nationwide amoxicillin shortage. (Amoxicillin is one of the medications used to treat strep throat.)
“Any number of kids dying of infection should be shocking news because kids aren't supposed to die,” Bartlett said. “Vigilance is important, but panic is not necessary. The news about antibiotic shortages is scary and frustrating and needs to be addressed on a systemic level. But as we continue to see all these viral illnesses, especially influenza, everyone should be on their guard in terms of watching their kids.”
The good news is that strep A infections can be treated with other antibiotics like penicillin.
“Amoxicillin tends to be the go-to drug for children since it tastes good and is given fewer times a day than penicillin,” Bartlett said. “While we always want to use the narrowest spectrum antibiotic available to treat an infection, we have many alternatives to treat [strep A] infections.”
Strep throat can be detected with a rapid test at the doctor’s office.
However, Bartlett said you may want to avoid testing your child for strep throat if they don’t have any symptoms. Up to 20% of children have strep A living in their throats at any time, she said, so a positive test could mean they’re prescribed antibiotics unnecessarily. In light of the amoxicillin shortage, “we want to be mindful of treating only those children with symptomatic [strep A] infections.”
Strep throat symptoms can include sore, painful throat, fever, red and swollen tonsils that may have white patches, red spots on the roof of your mouth, and swollen lymph nodes in the front of your neck. Headache, stomach pain, nausea, or vomiting are other common symptoms, especially in children, the CDC says. The development of a rash is called scarlet fever.
People who go on to develop invasive strep A may feel these symptoms, but their progression will occur much more rapidly, Bartlett said.
Strep throat can happen to anyone, but it’s more common in kids between 5 and 15 years old and older adults.
What to know about invasive strep A and its symptoms
About several million cases of noninvasive strep A illnesses occur each year, according to the CDC, including pharyngitis (strep throat), scarlet fever, tonsillitis, and impetigo, also called school sores — a highly contagious skin infection that mainly affects infants and kids, causing red sores to form around the mouth and nose.
These conditions can lead to complications like post-streptococcal glomerulonephritis (kidney disease) and acute rheumatic fever, but it’s rare.
Some infections, however, go on to cause invasive strep A, particularly in people with weakened immune systems.
Some of the complications of invasive strep A include cellulitis, which is a serious skin infection, blood infections, necrotizing fasciitis (an infection that destroys tissue under the skin, known as the “flesh-eating disease”), pneumonia, and STSS.
The CDC estimates that anywhere between 14,000 and 25,000 cases of invasive strep A occur each year in the US, according to data from the last five years; between 1,500 and 2,300 people die annually from it.
How does strep A spread?
The bacteria spread via respiratory droplets that disperse in the air through coughing, talking, or sneezing. Drinking from a sick person’s cup or touching a contaminated door handle then touching your mouth, for example, can get you sick. You can also catch the bacteria by touching infected sores on people’s skin.
Keep in mind, however, that even people without symptoms can still spread the bacteria, although those who get sick are much more contagious.
On rare occasions, people can spread the bacteria through food that’s not handled properly, the CDC says.
It typically takes two to five days after exposure to the bacteria before you would feel sick.
How to treat and prevent strep A infections
There is no vaccine for strep A, but several candidates are in development, the CDC says.
Antibiotics like amoxicillin and penicillin can treat strep A infections. They’re rarely used to prevent people from getting sick, but in certain situations they can be prescribed to some people who are exposed to someone with an invasive strep A infection.
People with mild illness are typically no longer contagious around 24 hours after beginning their medication.
One of the best ways to avoid strep A illnesses is to get your flu shot, Bartlett said, given influenza infections are often associated with secondary bacterial infections like strep throat. Ensuring you and your children have been vaccinated against chickenpox is important, too, she said, because chickenpox “predisposes people to severe invasive strep A infections.”
Otherwise, stick to your basic hygiene practices to avoid getting sick: wash your hands, cover your mouth and nose when coughing or sneezing (preferably with a tissue), don’t share food or drink utensils with others, and stay home when sick.