The UK Health Security Agency (UKHSA) said there had been a rise in rare invasive Group A strep this year, particularly in children under 10, with a number of deaths in England and cases across the UK.
Group A strep bacteria can cause many different infections, ranging from minor illnesses to deadly diseases.
Illnesses include the skin infection impetigo, scarlet fever and strep throat.
While the vast majority of infections are relatively mild, sometimes the bacteria causes a life-threatening illness called invasive Group A Streptococcal disease.
Here’s everything you need to know.
What is Strep A?
Group A Streptococcus (Group A Strep or Strep A) bacteria can cause many different infections.
The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.
Infections cause by Strep A range from minor illnesses to serious and deadly diseases.
They include the skin infection impetigo, scarlet fever and strep throat.
While the vast majority of infections are relatively mild, sometimes the bacteria cause life-threatening illness called invasive Group A Streptococcal disease.
How are Strep A bacteria spread?
The bacteria are spread by contact with an infected person or by contact with infected skin lesions.
Bacteria can be passed from person to person by close contact such as kissing or skin contact. People can catch it through close contact and from coughs and sneezes and outbreaks can sometimes happen in places like schools and care homes.
The risk of spread is greatest when somebody is ill, such as when people have strep throat or an infected wound.
What is invasive Group A Streptococcal disease?
Invasive Group A Strep disease is sometimes a life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle or lungs.
Two of the most severe, but rare, forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.
Necrotising fasciitis is also known as the “flesh-eating disease” and can occur if a wound gets infected.
Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure/shock and damage to organs such as the kidneys, liver and lungs.
This type of toxic shock has a high death rate.
What can Strep A lead to? Can these illnesses be treated?
Strep A infections such as scarlet fever and impetigo are treated with antibiotics.
After a full 24 hours of antibiotics, people are generally thought to no longer be contagious.
Anyone thought to have invasive Group A Streptococcal disease should seek medical help immediately. Antibiotics, other drugs and intensive medical attention are likely to be needed.
How to protect children from Strep A
Dr Belinda Griffiths, a general practitioner who specialises in family health at The Fleet Street Clinic (fleetstreetclinic.com), agrees, saying incidences “are rare”, but the fact that there have been deaths means “we can’t afford not to pick these cases up”.
Children under 10 are particularly vulnerable to Strep A “because they haven’t been exposed to it”, says Griffiths. “And they’re a group where if one in a cohort gets it, the whole group will be exposed to it, because they spread bugs like wildfire – children much more than adults.
“We don’t tend to go around in such close contact. It is possible for adults to get Strep throat, but it’s much less common.”
“It’s very difficult with small children – because they all cough in each other’s faces,” Griffiths says.
While you can teach children to wash their hands regularly, sneeze into tissues and avoid anyone who has a cough, Griffiths adds: “Very small children won’t pay any attention to that at all. You can try, but they’ll all be running around, playing chase and the contact is there. You can educate them up to a certain point, but with very small children, it’s difficult to do that.”
What is Scarlett Fever?
Someone who has Scarlett Fever may have what is called a Strawberry tongue, with Scarlett Fever being a notifiable disease, meaning health professionals must inform local health protection teams of suspected cases in order to try and bring possible outbreaks brought under control.
The disease causes a rash and flu-like symptoms, including a temperature, sore throat and swollen neck glands, and can result in a sandpapery feel on the skin.
When should you see a doctor?
Strep throat is different from a regular sore throat and the pain can come on very quickly.
Symptoms include pain when swallowing, fever, and red and swollen tonsils – sometimes with white patches or streaks of pus.
The NHS recommends people see their GP if a sore throat does not improve after a week, if they are worried or if they have a high temperature, or feel hot and shivery.
People with weakened immune systems such as those having chemotherapy should also see a doctor.
Impetigo is a skin infection which starts with red sores or blisters that then burst, leaving crusty, golden patches. The infection can be treated with antibiotics.
Scarlet fever symptoms are often flu-like, including a high temperature, a sore throat and swollen neck glands.
A rash appears 12 to 48 hours later, starting on the chest and stomach and then spreading.
A white coating also appears on the tongue which peels, leaving the tongue red, swollen and covered in little bumps (often called “strawberry tongue”).
Signs of necrotising fasciitis include fever (a high temperature above 38C), severe pain and swelling, and redness at the wound site.
Early signs and symptoms of toxic shock may include fever, dizziness, confusion, low blood pressure, rash and abdominal pain.
What is causing Strep A outbreak?
A lack of mixing due to the Covid-19 pandemic could be behind a drop in immunity to infections such as Strep A, a leading expert has said.
Dr Simon Clarke, microbiologist at the University of Reading, said he had not seen any evidence that a new strain was behind the current crop of cases affecting children.
Professor Beate Kampmann, from the London School of Hygiene & Tropical Medicine, said: “Group A strep is a well known bacterium that usually causes fever and throat infections and sometimes a condition called scarlet fever. These tend to be fairly harmless.
“In very rare circumstances when the bacterium produces a toxin it can gain access to the bloodstream and cause really serious illness such as heart inflammation, necrotising fasciitis, sepsis and toxic shock with organ failure, and this unfortunately appears to have been the case of the tragic deaths of the schoolchildren.”
She said that “if parents are concerned about their child looking very ill with symptoms of fever, vomiting, muscle aches, and rash they should always promptly seek medical advice.”