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Invasive Strep Infections Double: CDC Study Reveals Alarming Rise in Cases
Reports indicate a concerning surge in invasive Group A strep infections. A recent study by the Centers for Disease Control and Prevention (CDC) has revealed a significant increase in these potentially serious infections, which more than doubled between 2013 and 2022. While most Group A strep infections result in mild conditions like strep throat, the spread of bacteria to the bloodstream and deep tissues can induce streptococcal toxic shock syndrome (STSS), a deadly condition.
Understanding Streptococcal Toxic Shock Syndrome (STSS)
Streptococcal toxic shock syndrome (STSS) is a severe bacterial infection with a high mortality rate, claiming the lives of approximately 30% of those affected. In advanced stages, STSS can lead to necrotizing fasciitis, commonly known as flesh-eating disease, and even organ failure. While antibiotics are usually prescribed for treatment, severe cases may necessitate surgical intervention, including the removal of infected tissue or even limbs.
Study Highlights Significant Increase in Invasive Strep Cases
The study, published in the Journal of the American Medical Association, indicated a substantial rise in invasive Group A Streptococcus (GAS) cases. Infections increased from 3.6 to 8.2 cases per 100,000 individuals. Examining data from ten states over the nine-year study period, researchers discovered over 21,000 invasive Group A infection cases, including nearly 2,000 fatalities.
Dr. Victor Nizet, a pediatrics professor at the University of California, San Diego, commented on the findings, stating to NBC News, “When you see this high number of deaths, extrapolate that across the country — we’re probably well into more than 10,000 deaths.”
Notably, prior to 2013, invasive strep rates had remained stable for 17 years.
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Who is Most Vulnerable to Invasive Strep Infections?
The CDC study identified specific populations at higher risk of contracting invasive Group A strep infections. These vulnerable groups include:
- Adults aged 65 years and older
- American Indian or Alaska Native individuals
- Residents of long-term care facilities
- People experiencing homelessness
- Intravenous drug users
Study authors emphasized that the threat posed by invasive strep has “substantially increased” for both high-risk groups and the general population.
Factors Contributing to Rising Infection Rates
Several factors are believed to be contributing to the increasing rates of invasive Group A strep infections:
- Increased Rates of Diabetes and Obesity: Both conditions can weaken the immune system, making individuals more susceptible to invasive strep and skin infections.
- Intravenous Drug Use: Injecting drugs directly introduces bacteria into the bloodstream, elevating infection risk.
- Fentanyl Use: The rise in intravenous fentanyl use may further exacerbate the issue. Fentanyl’s short-acting nature can lead to more frequent injections and riskier practices, such as needle sharing, particularly within homeless populations.
Evolving Strep Strains and Antibiotic Resistance
Researchers suggest that Group A strep strains are evolving and becoming more varied. These newer strains may be more prone to causing skin infections rather than typical throat infections. Of further concern, these strains may exhibit increased resistance to certain antibiotics, specifically macrolides and clindamycin. While penicillin remains the standard treatment for strep, clindamycin is often added when infections progress to STSS.
Pediatric Infection Rates: A Surprising Observation
Interestingly, despite a prior CDC alert and numerous reports of pediatric invasive strep cases in 2022, the study did not find a corresponding increase in infection rates among children.
Dr. Allison Eckard, division chief for pediatric infectious diseases at the Medical University of South Carolina, expressed surprise at this finding, telling NBC News, “That was, to me, the most shocking part of the study. Because clinically, we are seeing what feels like an increase. We are just seeing more severe cases, more unusual cases, more necrotizing fasciitis, and cases that do raise concern that something is going on more nationally.”
Dr. Eckard emphasized the need for further research to determine if certain strep strains are becoming more virulent or widespread.
Call for Strep Vaccine Development
The escalating case numbers and significant impact of invasive Group A strep infections have prompted researchers to advocate for the development of a strep vaccine, especially considering the growing concerns about antibiotic resistance.
Dr. Joshua Osowicki, a pediatric infectious diseases physician at Royal Children’s Hospital Melbourne and co-author of an accompanying editorial, described the situation as a “pandemic in plain sight.” He added, “because we haven’t managed to control it, we look elsewhere for easier targets, but this is one of those hard targets that I think really needs to dedicate to dealing with.”