Deadly Strep A outbreak: You're at risk if you live in these U.S. states

‎Strep throat is a familiar ailment for many, especially children, often resolved with a quick course of antibiotics. But the bacteria behind it—Group A Streptococcus (GAS)—can do far more damage than a sore throat. Increasingly, these bacteria are causing invasive and life-threatening illnesses such as necrotizing fasciitis, also known as flesh-eating disease.

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‎Life-threatening Strep A infections surge.

‎Cavallini James/BSIP/Universal Images Group—Getty Images

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‎A new report published on April 7 in JAMA by researchers at the U.S. Centers for Disease Control and Prevention (CDC) highlights a worrying trend: cases of invasive Group A strep have been steadily climbing in the U.S. over the past decade. The findings reveal not only a rise in cases from 2013 to 2022 but also growing resistance to commonly used antibiotics.

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‎“This trend may continue unless there is a reduction in the underlying factors that increase risk for invasive Group A strep or there is an effective preventive measure such as a vaccine,” said Dr. Christopher Gregory, lead author and CDC infectious disease expert.

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‎What Is Group A Strep?

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‎Group A Streptococcus bacteria are responsible for a spectrum of illnesses, from the common strep throat to more severe infections like sepsis, toxic shock syndrome, and necrotizing fasciitis. While typical strep throat remains a non-invasive condition, danger arises when the bacteria infiltrate sterile parts of the body—such as the bloodstream or lungs—triggering invasive disease.

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‎Not all strains of Group A strep are alike. The CDC study identified seven to eight dominant types responsible for the majority of invasive cases. These types often circulate in unpredictable cycles, making outbreaks hard to forecast.

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‎How Common Is Strep A?

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‎In a separate study, Dr. Robert Frenck and his team found that 15% to 20% of children carry the bacteria in their throat, often without any symptoms. If these carriers suffer skin wounds or sores, they may be at heightened risk of developing an invasive infection.

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‎“Breaks in the skin can act as entry points for the bacteria,” explains Dr. William Schaffner, a co-author of the JAMA study and infectious disease expert at Vanderbilt University. “Touching your mouth and then your wound can allow bacteria from the throat to enter the bloodstream.”

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‎Who Is Most at Risk?

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‎The study, which analyzed data from more than 34 million people in 10 states, found that invasive strep A cases disproportionately affect certain vulnerable populations: older adults, individuals in long-term care facilities, the homeless, and intravenous drug users. Chronic conditions such as diabetes, obesity, and heart disease also heighten susceptibility.

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‎“It's not always that the bacteria are stronger,” says Frenck. “It’s often that the host—meaning the person—is weaker.”

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‎Can Group A Strep Cause Flesh-Eating Infections?

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‎Yes. Necrotizing fasciitis, a rare but often fatal condition, is one of the most severe manifestations of invasive strep A. Infections often begin when the bacteria enter open wounds—frequently from natural water sources like lakes—and spread rapidly through the body's soft tissue.

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‎Testing and Diagnosing Strep A

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‎While rapid antigen tests can detect strep throat in minutes, they’re not always accurate. Culturing a sample remains the gold standard, though results take longer. Physicians are increasingly being encouraged to diagnose based on clinical symptoms—such as pus on the tonsils, swollen lymph nodes, and fever—before resorting to antibiotics.

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‎“A runny nose or cough usually points away from strep,” says Frenck. Overprescription of antibiotics risks breeding drug-resistant strains, making accurate diagnosis crucial."

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‎Treatment and Resistance Challenges

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‎Penicillin continues to be a reliable treatment for most strep A infections. However, the CDC’s report found a notable increase in resistance to other commonly used antibiotics, such as macrolides and clindamycin. Resistance rates rose from 12.7% to 33.1% over the study period.

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‎“We used to have multiple effective options,” says Schaffner. “Now, choosing the right antibiotic requires knowing what’s circulating in your area.”

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‎Is a Vaccine Coming?

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‎Despite decades of research, no vaccine for Group A strep has reached the market. The challenge lies in the bacteria’s variability—different strains circulate at different times, and targeting all effectively remains difficult. Vaccine developers are also wary of triggering serious immune-related complications, such as rheumatic heart disease.

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‎How to Protect Yourself

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‎While the science of prevention continues to evolve, health experts recommend basic hygiene and skin care as your best defense. Wash hands regularly, treat skin wounds promptly, and avoid swimming in natural waters with open cuts. Public health measures focused on managing chronic diseases like diabetes may also help reduce the risk of invasive infections.

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‎As cases of invasive strep continue to rise, so does the urgency for awareness, early detection, and responsible antibiotic use. Until a vaccine becomes available, prevention remains our strongest shield against this escalating bacterial threat.

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‎Where Invasive Strep A Is Surging Across the United States

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‎While the Centers for Disease Control and Prevention (CDC) does not publish a definitive list of U.S. states with the highest rates of invasive Group A Streptococcus (GAS) infections, several states have reported elevated incidence rates based on available data.

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‎1. Idaho

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‎Idaho has experienced a significant increase in invasive GAS infections, with incidence rates rising from 1.04 to 4.76 cases per 100,000 persons between 2008 and 2019. Notably, streptococcal toxic shock syndrome (STSS) cases increased 0% to 6.4% during this period.

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‎2. Texas

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‎Texas has experienced fluctuating incidence rates of invasive GAS infections, with rates ranging from 1.3 to 3.5 cases per 100,000 persons between 2012 to 2019. The state has provided detailed data on GAS infection rates, which can be accessed through the Texas Department of State Heath Services.

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‎3. Utah

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‎Utah observed an increase in invasive from 3.5 to 9.8 cases per 100,000 persons between 2002 and 2010. The state's data indicates a rising trend in incidence during this period.

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‎4. Illinois

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‎Illinois reported elevated cases in invasive GAS infections, including five pediatric deaths in 2023. The state has acknowledged that cases remain elevated above pre-pandemic levels in some areas.

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‎5. Other States 

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‎While specific data for other states is limited, the CDC's Active Bacteria Core surveillance (ABCs) program monitors invasive GAS infections across 10 U.S. sites, which include a mix of urban and rural areas. This surveillance provides a comprehensive understanding of GAS infection trends across different regions.

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‎For the most current and detailed information on invasive GAS infection by state, it is advisable to consult the CDC's Bact Facts Interactive dashboard or contact state health departments directly.