Why Do My Kids Keep Getting Strep?

My son is 8.5 years old and attends a public school in Austin, Texas. He and several of his friends, not all in the same class, seem to be continually getting strep throat this school year. My son has had it at least three times from November 2022 to April 2023, and he has missed an unusually large amount of school this year with fevers. Other friends’ kids have had strep six times just this school year! This seems crazy. Is 2023 a particularly bad year for strep? Is this some sort of COVID payback, since their immune systems missed some exposure to germs during their mask-wearing kindergarten year? And could a contributor be that they aren’t socially mature/aware enough to stop picking their freaking noses and wash hands regularly, so they keep reinfecting each other? What is going on, and what should we do to stop this strep cycle?
—Strep, please stop!

Group A strep is a bacteria that causes a variety of illnesses of varying severity, the most common of which is strep throat. Strep throat is the cause of a large share of sore throats in children, and there is a quick swab test that can be done by your doctor to detect it.

It is a bad period for strep. We cannot observe trends in strep throat directly, because it’s not a disease that the CDC tracks (there are some illnesses that are “notifiable diseases,” so the CDC must be told about a positive test; this isn’t one of them). However, the CDC does track serious strep infections that result in streptococcal toxic shock syndrome (STSS). To be clear: this is very rare, but since it’s caused by the same bacteria as strep, we can use it to get a sense of trends over time.

These data show a spike in strep. Cumulatively, there are 145 cases of STSS reported so far in 2023. This is running well ahead of the 49 cases that occurred by the same time of year in both 2022 and 2021. I will note that the year-to-date number in 2019 was 196, so this isn’t an unusual year relative to pre-pandemic. As with many infectious agents (other than COVID), illness rates were depressed during the pandemic. This a return to normal, though in this case not a return to above normal.

The repeat infections you describe — while they do happen — are unusual. People definitely can get repeated strep infections over short periods (it is not like a virus in the sense that once you fight it off, you typically have some medium- to long-term immunity). This can happen for those who are immunocompromised, but it can also happen if there is a continual strep source.

In this case, it seems possible that the kids are just constantly passing the bacteria back and forth. It’s also possible that someone in the vicinity is an asymptomatic strep carrier. Either way, it’s not clear there is much to do about it other than to encourage hand washing, discourage nose picking, treat them when they are sick, and wait for the summer.