Three doctors explain what you need to look out for
There has been a significant increase in the number of children with strep A infections in the UK over the past month compared with the same period in previous years. Sadly, nine children have died as a result of complications of this bacterial infection.
The UK Health Security Agency (UKHSA) has issued a statement about what parents can look out for as signs of illness, and an alert notifying doctors about the rise in cases.
Group A streptococcus (also called GAS or strep A) is a type of bacteria that can live in the back of the throat or on the skin, especially in children. It can spread between people through close contact or coughing and sneezing.
In most people, it either causes no illness or only mild throat or skin infections or scarlet fever. Children with scarlet fever have a sandpaper-like rash over their body, often with fever and sore throat and a “strawberry tongue” – where the tongue is red with a white covering.
While most rashes and sore throats in children are caused by viruses and so aren’t helped by antibiotics, these mild strep A bacterial infections can be easily treated with antibiotics. Taking antibiotics for strep A helps prevent any complications or spread to household and school contacts.
Children with scarlet fever should be kept at home until at least 24 hours after starting antibiotics to avoid passing on the infection.
Very rarely, strep A escapes from the skin or throat and causes a condition known as invasive group A strep, or iGAS. This leads to serious illness or even sepsis, including infections of the bloodstream, joints, bones, muscles, lungs, brain or deep skin layers (necrotising fasciitis). Children with invasive group A strep need to be treated in hospital with intravenous antibiotics.
There has also been an increase in the usual winter respiratory viruses going around, with a particularly early and steep rise in cases of respiratory syncytial virus (RSV), a common childhood infection. During the pandemic lockdowns, fewer children were exposed to these viruses and therefore did not build up immunity to them, which has been termed “immunity debt”. Due to increased social mixing, many children are now picking up these viruses.
The increase in respiratory viruses this winter might be part of the reason behind the rise in cases of more serious invasive group A strep. The lining of the nose and throat becomes inflamed during viral illnesses, and this may allow the strep A bacteria to get into the bloodstream or the lungs.
Invasive group A strep is also more common in people with a weakened immune system, and people with skin sores or wounds, such as with chickenpox. These all help the bacteria get into deeper parts of the body, turning a mild infection into a serious one.
The rise in mild strep A infections may be due to increased social mixing and high amounts of circulating bacteria. Since a very small percentage of strep A infections lead to serious illness or invasive group A strep, it makes sense that the number of severe infections has risen as the overall numbers of mild and symptomless strep A infections have increased.
Public health and microbiology experts continuously analyse the circulating strains of strep A. The strains circulating in the UK at the moment are the same as those seen in recent years, so it is unlikely that a new or particularly aggressive strain is responsible for the increase in cases.
Very Rare, But Look Out For These Symptoms
While it is important to be aware of the increase in strep A infections, invasive group A strep is still thankfully very rare. Most people with strep A won’t develop invasive infection even if they have skin wounds or viral respiratory infections.
Signs to look out for are the same as for other serious illnesses in children:
- a high fever that is not settling in a child who seems unwell
- severe muscle aches
- pain in one area of the body
- a spreading redness on the skin
- difficulty breathing
- excessive sleepiness or irritability.
Further information about when parents should be worried about their child can be found on the Healthier Together website.
Parents and carers are understandably likely to be feeling very anxious about strep A infections at the moment, but the risk for each child remains very small.
If too many children with mild infections attend the GP or emergency departments, it will make it harder for the very few children with severe disease to access care. The advice on the Healthier Together website will help parents to know when to seek medical attention.
ABOUT THE AUTHORS
Chrissie Jones is an Associate Professor of Paediatric Infectious Diseases at the University of Southampton. I deliver inpatient and outpatient care to children with complex infections across Wessex. I lead the congenital infection service for the region. My research focusses on interventions in pregnancy to prevent infections in early life. I lead studies to reduce the risk of CMV acquisition in pregnancy by simple behavioural modifications. I am leading studies in the UK of CMV vaccines in women of childbearing age and adolescents. I am a medical advisor to the charity CMV Action and co-director of the European Congenital CMV Initiative. I am an expert in the field of maternal vaccination and have led pertussis, RSV, GBS and COVID-19 vaccine clinical trials in pregnancy. I am the co-director of IMPRINT (imprint-network.co.uk), a global network of experts in vaccination in pregnancy and early life.
Anastasia Theodosiou is an Infectious Diseases and Microbiology doctor, and MRC Clinical Research Training Fellow at the University of Southampton. Her research interests include the human microbiome, and whether the microbiome can be modified to promote health, especially in pregnancy and childhood. She is the Principal Investigator on a human challenge study in which pregnant women are given nose drops containing harmless bacteria, to study the effect on the newborn microbiome. Anastasia is passionate about medical education and public engagement, and she has won national awards for research presentations and science writing. She is especially interested in the intersection between medicine and social science, and has an MPhil from the University of Cambridge in the political history of abortion, IVF and embryo research in the UK.
Elizabeth Whittaker is Senior Clinical Lecturer in paediatric infectious diseases and immunology. She divides her time between Imperial College London and the Department of Paediatric Infectious Diseases and Immunology, St. Marys Hospital, London where she is a Consultant. Dr Whittaker is the co-lead for HCID (high consequence infectious diseases) at St Marys. She is on the RCPCH COVID expert advisory group and the NHSE National Paediatric COVID Treatment Advice lead . Together with colleagues in paediatric infectious diseases at Imperial College and Imperial College Healthcare NHS Trust, as well as other paediatric centres in the UK, she described a novel inflammatory syndrome in children known as PIMS (paediatric inflammatory multisystem syndrome) or MIS-C (Multisystem inflammatory syndrome in children). She is a co-investigator on the NIH funded PREVAIL study exploring diagnostic and prognostic markers for COVID related conditions. She is the co-lead for the Pan London Post-COVID service for Children and Young People (CYP) and a co-investigator on the NIHR funded CLoCK study looking at prevalence of Long COVID in CYP. She is also a co-investigator on other studies exploring pathogenesis and treatment of post COVID syndromes in CYP.
This article is courtesy of The Conversation.
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