Strep Throat Cases Are 30 Percent Higher Than Previous Peak in 2017

Strep throat infections have hit a new six-year peak, and have maintained abnormally high levels into spring, even compared with prepandemic rates.

An April 19 report from Epic Research found that in February 2023, strep cases were 30 percent higher than in February 2017, the last time cases peaked.

Many different strains of group A Streptococcus, the bacteria that cause strep, circulate every year. According to Bessey Geevarghese, DO, an assistant professor of pediatric infectious diseases at Northwestern Medicine in Chicago, most of the time they do not cause severe illness.

But the United States has also seen an increase in severe infections, called invasive group A strep. The serious condition occurs when a strep infection spreads to the deep tissue or bloodstream, and it can be fatal.

The Centers for Disease Control and Prevention (CDC) issued a warning in December when it first detected a rise in invasive group A strep infections. The agency noted that in addition to kids, people who live in long-term care facilities, those who are unhoused, over age 65, those with certain conditions such as diabetes and chronic kidney or cardiac disease, and American Indian and Alaska Native (AIAN) populations were at high risk of severe strep infections.

“It’s always been around, but since we’re seeing an increase in cases, we’re also seeing more cases of this rare presentation,” says Dr. Geevarghese.

Strep Is Infecting Adults This Year, Too

Before the pandemic, strep cases followed a seasonal pattern, the new report said, typically starting around September, peaking in February, and tapering off by April. It’s unusual for a high number of cases to persist this late in the year. But according to Geevarghese, this buck in the trend is to be expected after two years of very low cases of many common communicable infections that usually strike in fall and winter, including strep.

“Naturally, when you get recurrent strep, you have some sort of innate immunity that protects you against future infection. But in the last two years, we haven’t seen a lot of strep,” Geevarghese says.

This break from immunity-boosting infections is likely driving high rates of strep infections not just in kids, but also in teenagers and adults, which is rather unusual. Because of repeated exposure, older kids, teenagers, and adults typically have more immunity to strep than younger children, which is why strep is less common in these age groups, says Geevarghese.

According to the CDC, severe strep infections dropped by 25 percent during the pandemic, to a record low. Masking and social distancing didn’t just curb COVID-19 cases; the measures also prevented other common infectious diseases from spreading.

Since the measures have now waned, higher cases of all respiratory illnesses, not just strep, could also be a factor driving more serious illness from strep infections.

“Starting in September we saw this rapid increase in respiratory viruses we haven’t really seen in the past few years, first in RSV, then in flu. Once the immune system is worn down from that, it’s easier for strep to infect and cause complications,” Geevarghese says. “When we see kids in the hospital for strep, many have had a different viral illness a week or two before their invasive strep disease.”

Still, cases of severe strep are rare.

“If you have strep it does not automatically mean you will have invasive disease,” says Geevarghese. “The peak ages where we see complications are the young kids, and adults that are 65 years and older and immunocompromised.”

How to Tell if It’s Strep

According to Geevarghese, if someone has a cough and runny nose, they shouldn’t expect strep to be the culprit and should not seek out a test. But if a person has a sore throat and a fever, they should get a strep test.

“Strep can definitely lead to invasive disease in a small population if not identified early and treated,” she says.

The Mayo Clinic lists the following as potential strep symptoms:

• Rapid onset of severe sore throat
• Painful swallowing
• Fever
• Swollen, enlarged lymph nodes in your neck
• Tiny red spots back of the throat or the roof of your mouth
• Red, swollen tonsils that may have white patches or pus

If someone is treated for strep throat but doesn’t seem to be getting better within 24 hours, Geevarghese says it may be time to go to the emergency room.

“If your child has muscle pain, a red nose that is rapidly progressing, or if any area of the body is red and swollen, if they have shortness of breath, vomiting that seems out of proportion to their illness, or a change in mental status, these would be reasons to bring them to the ER,” she says.

Although physicians aren’t used to seeing such a spike in cases, “we know how to treat it,” says Geevarghese.

Despite Antibiotic Shortages, Medicines Are Still Available to Treat Strep

The United States is experiencing a shortage in some of the antibiotics used to treat strep, but there are other antibiotic options, and there aren’t shortages of the IV antibiotics needed to treat invasive infections.

“We’ve had some shortages, but not to the point where we can’t provide adequate care,” Geevarghese says.