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Pediatricians urge watching for these less-known strep throat signs as cases stay high

Strep infections surpassed pre-pandemic levels this spring, and cases still remain high among children as the country faces an amoxicillin shortage.
/ Source: TODAY

Although the winter respiratory virus season is ending in the United States and summer is quickly approaching, doctors are still seeing an alarming level of strep infections around the country.

Strep has been surging in the U.S. since last fall and remains high, especially among young children. Pediatricians have warned about the "explosion" of cases, including those with few or atypical symptoms — which may be harder to diagnose against a backdrop of other viruses and seasonal allergies, previously reported.

Strep throat at highest level in five years

According to new data published this week, cases of strep throat in the last few months have already surpassed pre-pandemic levels, hitting the highest rates seen since 2017.

A new analysis from Epic Research, which provides insights and trends based on electronic health records, found that rates of strep throat were nearly 30% higher in February 2023 than during the last peak in February 2017.

In the report, researchers noted that cases of strep dropped dramatically in March 2020, and remained relatively low until September 2022, when cases began rising again. Since then, infection rates have surged and remain high as summer approaches.

According to Epic Research's analysis of the surge this spring, strep throat was most commonly diagnosed in children ages 4 to 13, but all age groups have seen an increase.

The U.S. Centers for Disease Control and Prevention said that unpublished surveillance data show that emergency department visits for strep infections reached a five-year high in February and March, NBC News reported on April 19.

Strep throat is a highly contagious bacterial infection of the throat and tonsils caused by Group A streptococcus bacteria, which most often affects children and teens. Although it can occur at any time of year, strep rates are highest between December and April, Dr. Victoria Regan, a pediatric specialist at Memorial Hermann in Houston, previously told

So while it is normal to see strep throat increase in the late winter and early spring, this season is the worst it has been in a long time. "Doctors are anecdotally reporting seeing many more cases than they've ever seen in the past," Dr. John Torres, NBC senior medical correspondent, said on the TODAY show in a segment aired April 12.

One pediatrician said that the level of strep he saw this spring was twice that of their worst year. “I’ve been in infectious diseases and pediatrics for 30 years, and I’ve never seen it this bad,” Dr. Greg DeMuri, pediatric infectious disease physician with UW Health Kids in Madison, Wisconsin, previously told

Strep bacteria can cause a range of illnesses

While the most commonly affected age group is children between the ages of 5 and 15, experts say they are seeing more strep throat among young children and infants, who are often presenting with milder or unusual symptoms, previously reported.

The CDC has also been monitoring an increase in cases of a rare and severe form of strep called invasive Group A strep (iGAS), since last fall. In December, the agency issued a health advisory warning about the rise in these rare infections among both adults and children and the multiple pediatric deaths reported since 2022.

Group A streptococcus bacteria can cause a range of illnesses, from strep throat to skin infections. Invasive strep occurs when the bacteria invades parts of the body it doesn’t normally affect, like the bloodstream. This can lead to a rare and potentially life-threatening illness, such as flesh-eating disease or streptococcal toxic shock syndrome.

Run-of-the-mill strep symptoms include a sore or scratchy throat, fever, pain when swallowing, red or swollen tonsils, headaches and body aches. It's spread between people through respiratory droplets produced by coughing or talking, for example, per Mayo Clinic.

But in children under 3, a strep A infection rarely manifests as a sore throat, per the CDC — in this age group, it usually causes a low-grade fever, congestion and a runny nose. Some doctors say they've recently seen more of these less common symptoms among kids, which can make it more difficult to detect or diagnose early.

Strep is typically diagnosed using a rapid strep test or a strep culture, both of which require a health care provider to administer.

Why is this year's strep season so bad?

According to experts, a possible explanation for the surge in strep infections this spring is that people are being exposed to more germs now after being shielded by COVID-19 restrictions over the last two years.

What we're seeing now is that strep infections are following a similar trajectory as respiratory syncytial virus (RSV) and influenza, which dropped dramatically from 2020 to 2021 and then surged beyond usual, pre-pandemic levels this fall.

“Part of it is during the pandemic, everybody was masking, (distancing) and following (hand) hygiene, so we had the lowest levels of strep we’ve seen in many years,” said Regan.

Now that people are being exposed to these viruses and bacteria again, especially children in schools, infections are rebounding to pre-pandemic levels or worse.

Strep is treated with antibiotics, such as penicillin or amoxicillin, which is currently in short supply in the U.S. due to increased demand, the TODAY show previously reported.

Strep throat drug shortage

The drug shortage only applies to the kid-friendly liquid version pf amoxicillin, and The American Academy of Pediatrics has published recommendations for alternative therapies — like crushed up amoxicillin tablets or capsules, or second-line antibiotics.

When strep throat is left untreated, a person can stay contagious for two weeks, and the infection can cause serious complications, such as ear or sinus infections, abscesses, rheumatic fever and kidney problems, per the CDC.

Pediatricians recommend parents get their children tested if they experience any strep throat symptoms or have direct contact with anyone who has recently tested positive for strep throat.