Two of Greater Manchester’s leading health experts have shared the most important things to know about Strep A, amid the climbing death toll from severe cases among children.
Across the UK, seven children in England, one in Northern Ireland and one in Wales have died due to complications from strep A bacterial infections since September.
Speaking to the Manchester Evening News , a GP and Manchester’s Director of Public Health gave the most important advice to worried families asking if schools will close, what symptoms to look out for, and when to take your child to A&E or call 999.
What is Strep A?
Dr Helen Wall, a GP from Bolton, and Greater Manchester’s Clinical Director Population Health and lead for immunisations and screening, told the M.E.N: “Strep A is a bacteria that we’ve known about for years and years, this is not a new bacteria. It’s carried on many of our skins and in our throats.
“About 20 per cent of us carry it without experiencing any symptoms whatsoever. And it’s responsible for a lot of the common infections that we see in general practice day-to-day - tonsilitis, impetigo which is a skin infection, cellulitis which is another deeper tissue skin infection and scarlet fever.
“The difference now is that unfortunately Strep A can, in some rare cases, cause what’s called invasive group A Streptococcal. That’s where the Strep A bacteria gets into places it wouldn’t normally and shouldn’t normally be.
“Things like getting into the bloodstream, into the muscles, into the lungs. And that’s when these children become extremely sick and we’ve seen some really sad cases.
“It’s important to stress that the majority of children that get Strep A will remain will or will have a mild illness that we can manage very simply.”
When should I take my child to the doctor?
“There’s a difficulty in that tipping point between when a child is well enough to stay at home and when they need to be seen. I get why parents are extremely anxious,” explains Dr Wall. “We’ve got increased activity in all of our primary care right now because parents are extremely concerned and are contacting general practice with any sick child which is absolutely fine - but generally speaking these children would possibly have a bit of a sore throat, a rash, probably a fever. But it is variable and can take many forms in coughs and colds.”
There are some symptoms which should be taken to a medical professional, including “if you are concerned that your child is not drinking and not weeing so they’re getting dehydrated, if they’re less responsive and less alert so they’re not communicating with you like they normally would, or they seem confused,” says the doctor. “If they’re particularly cold - hands, feet, centre of them - their circulation doesn’t seem like it should do.
“If you’ve got a tiny baby under three-months-old and their fever is more than 38C or between three and six-months and their fever is more than 39C, then that is a concern.
“But if the child is well and running about and happy - they might have a cough or cold but they’re perfectly well, eating and drinking, weeing as normal, playing - we wouldn’t necessarily be overly concerned about a child like that.”
Early treatment with antibiotics can ensure the illness remains mild. Other symptoms can include signs like strawberry tongue or sandpapery rashes.
When do I need to call 999 or go to A&E?
Dr Wall says: “Any child with any illness, if their breathing is altered - if they’re struggling to get breath in or it looks like they’re having pauses in their breathing, or they’re sucking in their ribcage or stomach which is a sign that they are using extra muscles to help them to breathe - that’s definitely a trip to A&E or 999.
“If they are unresponsive, if they are not communicating with you at all, that’s definitely an A&E job. If they’ve got a rash that doesn’t disappear under pressure, that’s a definite A&E trip.”
What ages are affected by Strep A?
Scarlet fever, one of the conditions caused by Strep A, generally affects five to 15-year-olds, says Dr Wall. But Strep A in general affects toddler-ages, from two years on, as well as all primary school-age children and into the early years of secondary school being the most at-risk.
Problems with Strep A are much less common in adults because they are likely to have come across it so many times already that they have developed immunity, continues Dr Wall.
The immunocompromised or those on medication reducing their immune strength are more at risk, “but this isn’t a cause for concern for us at present” says the GP.
“If the elderly are frail and vulnerable in terms of their immunity or clinical situation, then you are at risk of all viruses and bacteria,” she added.
How is Greater Manchester handling the outbreak?
Manchester’s Director of Public Health David Regan told the M.E.N. that the region, which is experiencing some cases of Strep A and Strep A-related illnesses, has ‘tried and tested plans for managing outbreaks in care homes and schools, learned during Covid, and done annually with influenza’.
Typically, these plans would have been in place in spring for an uptick in scarlet fever, but after lockdowns during the pandemic, the illnesses are not following the normal seasonal patterns. Instead of spring, there is a peak in Strep A and scarlet fever now, he says.
If there are two or more linked cases at a school, for example, staff notify health protection teams, David shared. The UK Health Security Agency (UKHSA) will assess the situation, and the outbreak management team will decide the plan with school and local authority.
“It happens normally when we have outbreaks of scarlet fever in schools and nurseries and it’s definitely happening now,” said the director.
'Bespoke advice’ is being provided to places at risk of an outbreak, such as schools, care homes, and prisons.
Will schools close?
The Department of Education and the UKHSA would look at risks within the community and then at actions to be taken on a national level. “At this stage in this particular situation, we’ve got no evidence that any decisions will be taken by the Department for Education in the lead up to Christmas,” explained David.
It is important schools are kept open, he says, not only for education but to provide a ‘warm and safe environment’ for children during the cost of living crisis.
Do I send my child to school if they have symptoms?
“Just as we did with Covid, where a child is very unwell or they may be infectious to others, we don’t want children coming to schools with flu, scarlet fever, chicken pox. That advice is really important. It really helps keep our schools open,” explains David. This will make a difference with onward transmission and stop Strep A from further spreading.
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.
The risk of spread is greatest when somebody is ill, such as when people have strep throat or an infected wound.
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