2 Colorado children die from strep A as the state sees a rise in cases

Evolving Strep
National Institute of Allergy and Infectious Diseases via AP
This handout image provided by the National Institute of Allergy and Infectious Diseases shows an electron microscope image of Group A Streptococcus (orange) during phagocytic interaction with a human neutrophil (blue). The same bacteria that cause simple strep throat sometimes trigger bloodstream or even flesh-eating infections instead, and over the years, dangerous cases have increased. Now researchers have uncovered how some strains of this bug evolved to become more aggressive.

Two children in Colorado have died of what’s called group A strep, according to the state health department.

Group A streptococci are bacteria commonly found in the throat and on the skin. Most infections are relatively mild, but occasionally, it causes much more severe and even life-threatening illnesses.

Both deaths were among children from the Denver area where group A strep is required to be reported to the Centers for Disease Control and Prevention’s Emerging Infections Program, and happened since Nov. 1, according to Brian Spencer, a spokesman with the Colorado Department of Public Health and Environment. Both were young children who were not yet in school.

The last reported death in a pediatric patient with group A strep in Colorado was in 2018.

More A strep hospitalizations than usual as Colorado sees more cases of RSV, flu and COVID

Spencer said 11 children have been hospitalized with group A strep in the last six weeks in the metro area. 

In comparison, there are typically one or two cases of these infections per month in children younger than 18. Recent cases range in age from 10 months to 6 years, but anyone of any age can get group A strep. Many of the recent cases also had a recent viral respiratory illness like COVID-19, flu or RSV.

“While we are still seeing a fairly low number of cases, the outcomes of group A strep in children can be severe, so we want Coloradans to be aware of the symptoms,” said Dr. Rachel Herlihy, the state epidemiologist. “People should call their child’s health care provider immediately if they develop new or worsening symptoms during their respiratory infection. Early treatment is critical to prevent initially mild group A strep infections from progressing to more serious illnesses.”

The rise in group A strep comes as Colorado has grappled with a wave of other illnesses, a triple whammy of respiratory viruses: RSV, flu and COVID-19.  Health officials in the U.K. reported several children had recently died after being diagnosed with it.

“We are seeing a lot of cases of really severe invasive group A strep,” said Dr. Suchitra Rao, an infectious disease specialist at Children’s Hospital Colorado. “ So then the next question is to try and understand is there anything different about this particular group A strep strain?” 

She noted that the health department is doing genetic sequencing to try to understand if the cases are all from the same strain or different strains. 

“We need to do a little bit of extra work to try and identify what it is about this pattern that we're seeing right now,” she said. “What's challenging is that these viruses can sometimes present and act very similarly to a bacterial infection.” 

What to watch out for

But in general, she said if a child isn't recovering the usual way over a cold or an ear infection, that's the time when there’s a slightly increased risk of having a concern for a bacterial infection.

 “And so that's usually the time you wanna be reaching out to your doctor, your medical provider, just to, to make sure that there isn't anything else that's going on,” she said.

Sometimes these bacterial infections appear to be a more prolonged illness with higher fevers, so the child just doesn’t perk up and turn the corner like they might with a viral infection.

“So if any of those sort of alarm bells are ringing in parents' minds, really (they should) have a low threshold to go in and get your child checked out,” Rao said.

She said other things should trigger a parent taking a child to the emergency department:

  • Persistent high prolonged fevers
  • Signs of having difficulty breathing, like using a lot of their accessory extra muscles to help them breathe or breathing very quickly
  • Not able to take food or liquids by mouth, or throwing up, with the risk of being dehydrated. 

“If they are looking lethargic or drowsy or difficult to rouse, there are certain emergency situations where you want to go straight to the emergency room,” she said. 

More about A strep

The health department said it’s still investigating the deaths. The agency said it’s also monitoring the increase in pediatric hospitalizations caused by group A strep, and working with hospital partners in a coordinating role to make sure resources are available for those who need them. 

People with group A strep sometimes have other, preceding illnesses or infections that might contribute toward or be the primary cause of death, which is determined by the coroner or medical examiner in that jurisdiction, according to the health department.

Group A strep is a bacteria that can cause many different infections. Group A strep infections most commonly cause sore throat, a mild and common condition that can be easily treated. While rare, group A strep infections may be severe and cause diseases like pneumonia, sepsis, toxic shock syndrome and necrotizing fasciitis. 

While there is no vaccine to prevent group A strep, there are steps parents, guardians, and caregivers (including child care facilities) in Colorado can take to help protect children and families, according to the health department. Children should be up to date with COVID-19, flu, and chickenpox vaccines, as getting these infections can increase the risk of acquiring a group A strep infection.

And people should stay home if they are sick, and everyone should also practice good hand hygiene — regularly washing their hands with soap and water or using an alcohol-based hand sanitizer with at least 60 percent alcohol and avoiding touching their face.