ODP has partnered with Infectious Disease Connect (ID Connect) to release a newsletter centered on the latest in health news. ID Connect is an organization that connects patients, pharmacists, and healthcare providers to infectious disease experts. ID Connect has led a series of educational “Town Hall” style webinars for ODP centered on providing pertinent health education, news, and trends. Those townhalls can be found on MyODP at this page.

ID Connect January Newsletter

Increase in Invasive Group A Strep Infections, 2022-2023

The CDC has noted an increase in invasive Group A Streptococcal (iGAS) infections among children in the United States  since November 2022. The increased number of pediatric iGAS cases in some areas has occurred in the setting of increased circulation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and other respiratory viruses.  The increased seasonal risk of iGAS disease for all age groups, the early recognition, diagnosis, and appropriate treatment of these diseases in children and adults is important this winter season.

Background:  

• Also known as Streptococcus pyogenes
• Gram-positive coccoid-shaped bacteria
• Tend to grow in chains
• Transmitted by respiratory droplets or direct contact
• Antibiotics typically cure most cases of GAS

Invasive Group A Streptococcus is defined as Group A Streptococcus isolated from a sterile body site (e.g:  blood, CSF, pleural fluid, bone, joint, muscle).  It can cause a range of illnesses, from pharyngitis, skin and soft tissue infections, sepsis, streptococcal toxic shock syndrome and necrotizing fasciitis. Invasive diseases are associated with high mortality rates and require immediate treatment, including appropriate antibiotic therapy. It is a reportable condition in many states. At this time, Pennsylvania has not identified a significant increase in pediatric or adult cases compared to previous years.

Groups of concern:

Individuals at higher risk for severe iGAS disease include those 65 years old and older, persons living in crowded living conditions/confined settings, immunocompromised, persons with underlying medical conditions such as cardiac disease, diabetes, skin diseases, surgical wounds, and injection drug use.

Transmission risk:

GAS infections can spread rapidly in congregate settings: long-term care facilities and homeless shelters. Facilities with patients at high risk for severe disease, including long-term care, should regularly review their DOH’s recommendations and public health professional resources for GAS.

 Recommendations for Healthcare Providers:

• Diligent clinical assessment and diagnostic sampling of suspected iGAS patients is needed to decrease transmission and monitor iGAS.   Obtain culture for suspected iGAS infections, including blood, wound, and pleural fluid cultures, as clinically indicated
•  Swift administration of treatment and implementation of Infection control and prevention strategies help prevent further transmission and infection.
• Be mindful of potential alternative agents for treating confirmed GAS pharyngitis in children due to the shortage of amoxicillin suspension.

Recommendations for the Public:

• Learn about the symptoms of necrotizing fasciitis, streptococcal toxic shock syndrome, and cellulitis.
• Seek medical care quickly if you think you, your child, or another family member has one of these infections.
• Make sure everyone in the household is up to date with flu and chickenpox vaccines, since getting these infections can increase the risk for getting an iGAS infection.

“Tripledemic”

Respiratory infections, such as influenza and respiratory syncytial virus (RSV) were noted early this winter season. Multiple respiratory viruses are co-circulating throughout the country: influenza, RSV, rhinovirus and adenovirus as well as COVID-19.

The previous years were atypical winter seasons due to mitigation against COVID-19.  Covid 19 mitigation practices used over the last 3 years may have decreased the circulation of many other respiratory viruses.  Because of this, many people, especially children may not have ever encountered them.  Most people were left uninfected.

However, with the increase in respiratory viruses circulating, we are reminded of the importance of mitigation practices: hand hygiene, wearing masks, vaccinations.

We encourage all who are eligible to receive their bivalent COVID-19 booster and their annual influenza vaccine, frequent handwashing, covering the nose or mouth when sneezing or coughing, environmental hygiene/disinfection, staying away from others when ill, wearing a mask to help slow transmission of these viruses and protect oneself from serious illness.