Risk Of Invasive Strep Infection Has Spiked, Study Warns: What To Know In RI

RHODE ISLAND — The risk of contracting a potentially life-threatening invasive group A strep infection is more than twice what it was a decade ago, according to a new Centers for Disease Control and Prevention study.

The number of group A strep, or GAS, cases was relatively stable for 17 years before the sharp increase from 2013-2022, according to the study, which was published Monday in the Journal of the American Medical Association.

Invasive group A strep occurs when the bacteria Streptococcus pyogenes invades normally sterile areas of the body, such as the bloodstream or tissues, leading to serious illnesses like necrotizing fasciitis, commonly called flesh-eating disease, and streptococcal toxic shock syndrome, which can cause organ failure.

Based on data on 21,312 patients from 10 states with a combined population of 35 million that track the data, the study found overall incidence of GAS increased from 3.6 to 8.2 per 100,000 population over the nine-year period. The states in the study were not specified.

Data from the Rhode Island Department of Health has shown a sharp increase in group A strep cases between 2018 and 2023. According to state data, there were 83 cases of GAS in 2023. That is a 93 percent increase in cases from when there were 43 in 2018.

Among those at the greatest risk of infections are adults 65 and older, American Indian or Alaska Native persons, residents of long-term care facilities, people experiencing homelessness, and people who inject drugs. Cases did not go up among children, as they did in 2022, when the CDC issued an alert on a spike in pediatric cases of invasive strep.

People who have group A strep infections can experience “very, very rapid deterioration” within 24 to 48 hours, going to feeling as if they have the flu to “fearing for their recovery” after emergency hospitalization in the ICU, Dr. Victor Nizet, a professor of pediatrics at the University of California, San Diego, told NBC News.

Among the 21,000 patients whose cases were reviewed, nearly 2,000 people died over the period of the study.

“When you see this high number of deaths, extrapolate that across the country — we’re probably well into more than 10,000 deaths,” Nizet told NBC.

The study calls for “accelerated efforts” to prevent and control infections, both in the general and high-risk populations, the authors said. A couple of possible explanations for the rapid increase in strep A:

• Rising rates of obesity and diabetes among older adults, which can cause skin infections and compromise immunity;
• Rising rates of IV drug use, which can allow the bacteria to directly enter the bloodstream.

The rise of infections among people experiencing homelessness — 807 per 100,000 — was “among the highest ever documented worldwide,” Dr. Christopher Gregory, a CDC researcher and an author of the study, told NBC.

Lifestyle choices aren’t the only factor. The bacteria itself is expanding and becoming more diverse, exploiting new opportunities for infection and increasingly becoming resistant to antibiotics used to treat strep infections, according to the study. New strains in recent years are more likely to cause skin infections than throat infections, researchers said.

Doctors have called for a vaccine against group A strep infections given the growing antibiotic resistance of the bacteria. However, Nizet told NBC that may not be feasible with top vaccine scientists leaving the Food and Drug Administration.

“The lack of vaccine is devastating,” Nizet said. “Of course, we’re concerned about the turn of attitudes at the FDA and the CDC that seem to be putting some sticks in the spokes of the wheel of vaccine development.”

In an invited commentary, Joshua Osowicki, of the Royal Children’s Hospital in Australia, and Theresa L. Lamagni, of the U.K. Health Security Agency in London, noted that while other high-income countries are experiencing increasing rates of invasive strep A cases, “the scale and character of the rise in North America is particularly alarming and illuminates the extent to which invasive GAS disease thrives in settings of social disadvantage and marginalization.”

“The pattern is evident in a shift in age distribution, with the CDC reporting that invasive GAS infection is more common in young adults now than in young children, along with high incidence rates among people experiencing homelessness, people who inject drugs, residents of long-term care facilities, and Indigenous peoples, particularly American Indian and Alaska Native individuals,” they wrote.

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