What You Need To Know
This advisory highlights the continued increase in invasive Group A Streptococcal (iGAS) cases reported in New Jersey and emphasizes the importance of promptly reporting cases and clusters, especially those occurring in long-term care facilities. Clinicians should be aware of these trends and consider iGAS as a possible cause of severe illness, including in those with concomitant/recent viral respiratory infections.
When suspected, obtain appropriate cultures and initiate early, aggressive treatment. Promptly report all iGAS cases to the local health department, and any case in a long-term care facility resident should be urgently reported for investigation.
Background:
- Group A Streptococcus (GAS) is most commonly associated with pharyngitis or skin and soft tissue infection but it may also, in rarer circumstances, cause serious invasive infections including necrotizing fasciitis or toxic shock syndrome.
- Invasive GAS (iGAS) refers to infection in the setting of culture isolation of GAS from a normally sterile site (most commonly blood but may include pleural, pericardial, joint, peritoneal or cerebrospinal fluid, muscle, bone, or other specimens obtained from surgery/aspirate of internal body sites), or from a wound when associated with necrotizing fasciitis or toxic shock syndrome (TSS). TSS may occur as a complication of iGAS disease in approximately one-third of cases.
- We are currently experiencing substantially higher than usual numbers of iGAS cases among all age groups in New Jersey. This increase is part of a national trend that is being observed in many other places.
- During the COVID pandemic, cases of invasive Group A strep initially declined, especially among children and those over 65 years of age. Starting at the end of 2022, cases began to rise again and in 2023, the number of iGAS cases reported in NJ exceeded counts from prior years.
- So far, this year, cases among all ages are greater than previously recorded levels and remain substantially higher than cases reported during the same time frame in 2023.
- iGAS cases may be associated with concurrent or antecedent viral infections - some iGAS cases reported in New Jersey have been associated with respiratory viral illnesses including COVID-19, adenovirus, metapneumovirus, rhino/enterovirus and influenza. iGAS can also be associated with varicella infection.
- Outbreaks of iGAS can and have occurred in long-term care facilities, where residents may be at particularly high risk.