Doctors should be on the lookout for a particular kind of invasive strep infection in children that can result in so-called “flesh-eating” disease and organ failure, according to health officials.
Shortly before Christmas, the U.S. Centers for Disease Control and Prevention issued an advisory on the recent increase in pediatric invasive Group A streptococcal infections, otherwise known as iGAS.
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A podium with the logo for the Centers for Disease Control and Prevention is seen in 2014 at the Tom Harkin Global Communications Center in Atlanta, Georgia.
It’s too early to know for certain whether the increase in such infections is what would be typical for a pre-pandemic season. But iGAS cases in children this season are above similar periods seen in the first two years of the COVID-19 pandemic. In any case, the number of iGAS infections nationally has been relatively low.
However, federal officials have been investigating a possible rise in iGAS infections in children at a Colorado hospital, and potential increases have been subsequently reported elsewhere.
These bacterial infections can cause potentially deadly illness such as necrotizing fasciitis — sometimes referred to as “flesh-eating bacteria” — as well as toxic shock syndrome that can cause organ failure and sepsis, an extreme and sometimes deadly bodily response to an infection. Another complication can be cellulitis, a bacterial skin infection that can lead to painful swelling.
Group A Streptococcus bacteria can cause more mild but still painful illness — such as streptococcal pharyngitis, commonly referred to as strep throat. Symptoms can include sore throat, pain when swallowing, fever, red and swollen tonsils, and swollen lymph nodes. Children can have symptoms that also include headache, stomach pain, nausea and vomiting. People with strep throat can also have a rash, which is known as scarlet fever.
By contrast, more dangerous iGAS infections “are associated with high mortality rates and require immediate treatment, including appropriate antibiotic therapy,” the CDC said.
Health authorities in Britain have been tracking cases of iGAS, which remain rare there, too. Authorities in early December reported five recorded deaths within a week of an iGAS diagnosis in children younger than 10 in England. During the last season where Group A streptococcal infections were particularly high, there were four deaths in the same age group over the same time period.
Exposure to someone with strep throat puts them at greater risk for an iGAS infection, the CDC said. Strep throat is common among school-aged children age 5 to 15, and typically peaks in the U.S. from December through April. Cases of iGAS are particularly high when flu levels are high, and this flu season is shaping up to be the worst in at least a decade.
People who are already sick with, or recently had, a viral infection such as flu or chickenpox are at higher risk for iGAS, according to the CDC. Seniors, nursing home residents, people with chronic medical conditions, those with wounds or skin disease, intravenous drug users, homeless people and Native American populations are all also considered to be at higher risk for iGAS.
The CDC is urging parents to familiarize themselves with symptoms of iGAS and seek prompt medical attention. Here’s a rundown of symptoms of the most dangerous complications:
- Necrotizing fasciitis: Early symptoms include a red, warm or swollen area of skin that spreads quickly, severe pain and fever. Later symptoms can include ulcers, blisters or black spots on the skin, change in color to the skin, pus or oozing from the infected area, dizziness, fatigue, nausea or diarrhea.
- Streptococcal toxic shock syndrome: Illness begins with fever and chills, aches, nausea and vomiting. But within 24 to 48 hours more serious symptoms develop, such as low blood pressure, a faster-than-normal heart rate, rapid breathing and organ failure. Failure of the kidneys, for example, can be detected if a person stops making urine. Liver failure can be detected if they’re bleeding or bruising a lot, and their eyes might turn yellow.
- Cellulitis: Symptoms appear as a red, swollen and painful area of the skin — commonly on the feet and legs — that’s warm and tender to the touch. “The skin may look pitted, like the peel of an orange, or blisters may appear on the affected skin. Some people may also develop fever and chills,” the CDC said.
To help reduce the chance of severe symptoms, health officials recommend getting vaccinated against flu and chickenpox, since viral infections of those illnesses puts people at higher risk for an iGAS infection.
An iGAS bacterial infection in someone who already has a viral infection of another disease may appear in a patient as ongoing or worsening symptoms after an initial improvement in sickness.
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Photo Credit: Monkey Business Images / Shutterstock
The challenges facing the healthcare sector in the U.S. are numerous. The U.S. lags behind other developed nations on many key metrics of health, including life expectancy, chronic disease burden, and avoidable deaths. The population has been growing older on average with the aging of the Baby Boomers, creating increased demand for health services. Longtime public health challenges like obesity, substance abuse, and mental illness have wide-ranging impacts on Americans’ overall health and well-being. And in the last few years, the COVID-19 pandemic has placed unusually heavy strain on healthcare providers and hospitals.
With these many interlocking and compounding challenges, the U.S. spends heavily to support the healthcare system. According to federal data, national health expenditures in the U.S. total $4.1 trillion per year, making up nearly 20% of the nation’s GDP. The bulk of this spending comes from the federal government, which contributes 36.3% of expenditures, and U.S. households, which account for 26.1%.
Often underappreciated in discussions of the U.S. health system is the role of state and local governments. States and localities frequently fund public hospitals, health inspections, mental health and substance abuse programs, water and air quality programs, and payments to private hospitals for public health services. State and local governments funded 14.3% of total national health expenditures in 2020.
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This spending is one of the most significant budgetary responsibilities of state and local governments. Health and hospitals represent the third largest spending category for state and local governments, behind only public welfare and elementary and secondary education. Collectively, governments spend $345 billion on health and hospitals each year, accounting for nearly 10% of all state and local spending.
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State and local spending on health and hospitals on a per-capita basis has also grown over time. In the year 2000, state and local governments spent $678 per capita on health and hospitals in inflation-adjusted dollars. By 2020, that figure had risen to $1,040—an increase of more than 50%.
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However, this trend has not played out the same in all locations. In fact, 13 states have seen a decline in health and hospital spending per capita over the last decade, led by Arizona, where spending has declined by more than 50%. In contrast, other states have seen rapid growth in health spending. Vermont’s inflation-adjusted state and local spending per capita more than doubled between 2010 and 2020, from $355 to $730, and Utah’s 96.2% rate of growth was not far behind.
Just as trends in health spending have varied by geography, total spending also looks different from state to state. Nationwide, states and localities spend around 9.9% of their budgets on health and hospitals, at a total of $1,047 per capita. But a number of states and localities spend well above these figures, including Wyoming, where the per-capita spending is nearly triple the national average, and South Carolina, where health and hospital spending represents nearly 20% of state and local expenditures.
The data used in this analysis is from the U.S. Census Bureau. To determine the states that spend the most on health and hospitals, researchers at HowtoHome.com calculated health and hospital spending as a share of total spending. In the event of a tie, the state with the greater total health and hospital spending per capita was ranked higher.
Here are the states that spend the most on health and hospitals.
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Shutterstock
Photo Credit: Agnieszka Gaul / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $999
- Total health & hospital spending: $6,747,518,000
- Total direct expenditures: $62,806,487,000
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Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 10.7%
- Total health & hospital spending per capita: $1,061
- Total health & hospital spending: $9,112,433,000
- Total direct expenditures: $85,243,956,000
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Shutterstock
Photo Credit: Photosbykaity / Shutterstock
- Health & hospital spending as a share of total: 11.2%
- Total health & hospital spending per capita: $1,078
- Total health & hospital spending: $10,748,283,000
- Total direct expenditures: $95,700,844,000
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Shutterstock
Photo Credit: Roschetzky Photography / Shutterstock
- Health & hospital spending as a share of total: 11.3%
- Total health & hospital spending per capita: $1,013
- Total health & hospital spending: $29,753,376,000
- Total direct expenditures: $263,279,685,000
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Shutterstock
Photo Credit: Andriy Blokhin / Shutterstock
- Health & hospital spending as a share of total: 12.2%
- Total health & hospital spending per capita: $1,677
- Total health & hospital spending: $66,029,051,000
- Total direct expenditures: $541,102,413,000
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Shutterstock
Photo Credit: photo.ua / Shutterstock
- Health & hospital spending as a share of total: 12.8%
- Total health & hospital spending per capita: $1,289
- Total health & hospital spending: $4,190,560,000
- Total direct expenditures: $32,812,538,000
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Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,557
- Total health & hospital spending: $4,925,808,000
- Total direct expenditures: $35,283,924,000
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Shutterstock
Photo Credit: mahaloshine / Shutterstock
- Health & hospital spending as a share of total: 14.0%
- Total health & hospital spending per capita: $1,623
- Total health & hospital spending: $12,487,009,000
- Total direct expenditures: $89,455,201,000
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Shutterstock
Photo Credit: picsbyst / Shutterstock
- Health & hospital spending as a share of total: 14.2%
- Total health & hospital spending per capita: $1,208
- Total health & hospital spending: $7,431,898,000
- Total direct expenditures: $52,380,770,000
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Henryk Sadura
Photo Credit: Henryk Sadura / Shutterstock
- Health & hospital spending as a share of total: 15.5%
- Total health & hospital spending per capita: $1,561
- Total health & hospital spending: $4,548,137,000
- Total direct expenditures: $29,333,928,000
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Shutterstock
Photo Credit: Sean Pavone / Shutterstock
- Health & hospital spending as a share of total: 17.1%
- Total health & hospital spending per capita: $1,597
- Total health & hospital spending: $4,736,972,000
- Total direct expenditures: $27,688,049,000
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Shutterstock
Photo Credit: Rob Hainer / Shutterstock
- Health & hospital spending as a share of total: 18.7%
- Total health & hospital spending per capita: $1,687
- Total health & hospital spending: $8,302,347,000
- Total direct expenditures: $44,406,818,000
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Shutterstock
Photo Credit: Jon Bilous / Shutterstock
- Health & hospital spending as a share of total: 18.8%
- Total health & hospital spending per capita: $1,665
- Total health & hospital spending: $17,650,732,000
- Total direct expenditures: $93,667,411,000
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Shutterstock
Photo Credit: Jacob Boomsma / Shutterstock
- Health & hospital spending as a share of total: 18.9%
- Total health & hospital spending per capita: $2,936
- Total health & hospital spending: $1,709,488,000
- Total direct expenditures: $9,029,287,000
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Shutterstock
Photo Credit: f11photo / Shutterstock
- Health & hospital spending as a share of total: 19.3%
- Total health & hospital spending per capita: $1,787
- Total health & hospital spending: $9,326,575,000
- Total direct expenditures: $48,273,596,000
