UK health officials are cautioning schools and parents on how to deal with Strep A infections after the deaths of multiple children in recent weeks. The UK Health Security Agency (UKHSA) has confirmed the latest death of a child who contracted Strep A while attending St John's School in Ealing, West London.
The death follows that of Muhammad Ibrahim Ali, aged four, who died at his home on November 14 after suffering a cardiac arrest, his heartbroken family have said. He attended Oakridge School and Nursery in High Wycombe, Buckinghamshire.
Yesterday, Victoria Primary School in Penarth, Wales, confirmed the death of another child who had contracted the infection, named as Hanna Reap by family friends. A six-year-old pupil at Ashford Church of England Primary School in Surrey also died from strep A at the beginning of last week.
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 five deaths of under-10s in England since September. A separate case has been reported in Wales, taking the known UK total to six.
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What is Strep A?
The NHS states that Group A Streptococcus (GAS) is the name given to a type of bacteria sometimes found in the throat or on the skin. In most people does not cause any symptoms - known as being "colonised", the NHS says.
Guidance for patients adds: "Group A Streptococcus usually causes mild illness like sore throats and skin infections.
"Rarely these bacteria can cause severe and life-threatening illness called invasive Group A streptococcal disease."
However, it can cause a range of skin, soft tissue and respiratory tract infections - meaning in the nose, throat and lungs.
How is Strep A passed along - and how can you stop it spreading?
The illness can be spread through coughs, sneezes and skin-to-skin contact. The NHS continues: "Many people carry Group A Strep harmlessly and do not develop illness. It can be passed from person to person by close contact such as kissing or skin contact.
"Most people who come into contact with Group A Strep remain well and symptom-free [but] some get mild throat or skin infections.
"Contracting invasive disease from a relative or household member is very rare. You can reduce the risk of picking up Group A Strep by always washing your hands thoroughly."
Those carrying the bacteria may have no symptoms, but are just as likely to pass on Strep A as those who have fallen ill and have visible symptoms.
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What are the symptoms?
The symptoms of group A streptococcal infection depend on where the infection develops in the body. Group A Strep can cause throat infection, scarlet fever or skin infections such ascellulitis or impetigo. These infections are usually treated with antibiotics
These are symptoms and signs of different effects of Strep A:
- Strep throat symptoms may include a sore throat and tonsils, pain when swallowing, fever, muscle aches and pains, and tiredness.
- Scarlet fever symptoms include a very red, sore throat, swollen glands and fever. Around 12 to 48 hours after infection, red blotches can appear on the skin, usually on the face, neck, underarms or groin. Red bumps can also form on the tongue, sometimes called a ‘strawberry tongue’.
- Impetigo causes sores on the skin that tend to form blisters. These blisters can burst and leave a moist area with a yellow brown crust at the edge.
- Cellulitis involves an area of skin becoming red and inflamed, painful and swollen, while the skin will often feel tight and warmer to the touch than the surrounding skin.
- Necrotising fasciitis is a serious skin infection that can cause deep, painful skin sores as well as fever, diarrhoea or vomiting, septic shock and organ failure.
“[Symptoms] include a sore throat, fever and minor skin infections and can be treated with a full course of antibiotics from the GP," says the UKHSA. "In rare incidences, it can be a severe illness and anyone with high fever, severe muscle aches, pain in one area of the body and unexplained vomiting or diarrhoea should call NHS 111 and seek medical help immediately.”
The UKHSA has also advised those who come down with the illness exclude themselves from nursery, school or work for at least 24 hours after they start antibiotic treatment.
What is invasive Strep A?
Very rarely it can cause severe illness when the bacteria get into parts of the body that are usually free from bacteria such as the lungs, blood or muscles. This is called invasive Group A Streptococcal disease.Invasive disease happens when the bacteria get past your body’s immune defences, explains the NHS.
This can happen when you are already ill or are on treatments, such as some cancer treatments, that affect your immune system. Two of the most severe types of invasive disease are necrotising fasciitis and toxic shock syndrome.
The symptoms can include:
- Fever (a high temperature above 38°C (100.4°F))
- Severe muscle aches
- Localised muscle tenderness - pain in one area of the body
- Redness at the site of a wound
- Vomiting or diarrhoea
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How common is it in the UK?
Since 2017, there have been on average just under 2,000 confirmed iGAS infections per season - usually from around September to March, reports Sky News.
The UK Health Security Agency (UKHSA) has said that the figures for the disease are higher this year compared to the previous two.
The increase in cases is likely the result of the withdrawal of measures implemented during the Covid-19 pandemic, they add.
Is Strep A (GAS) dangerous and am I at any increased risk of this disease?
It can be a serious illness, but if treated promptly with antibiotics it is less of a threat. The NHS says people at risk of catching the infection include those who are:
- In close contact with someone that has Strep A
- Over the age of 65
- Have HIV
- Use steroids or other intravenous drugs
- Have diabetes, heart disease or cancer
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What should I do if I have symptoms of invasive disease?
You should contact your GP or get medical advice straight away if you think you have any of the signs and symptoms of invasive disease, says the NHS. Tell your doctor if you have been in contact with someone who has had Group A Strep recently.
Your GP will most likely ask you to come into the surgery to be examined.
How will I be cared for if I have invasive Group A Streptococcal disease?
Group A Strep disease can be treated with antibiotics. In severe cases surgery (an operation) may be needed, according to the NHS. If you are in hospital you will most likely be looked after in a room on your own and the staff caring for you will wear aprons and gloves and, in some cases, a face mask.
Your visitors will be asked to wear aprons and gloves when they visit and to wash their hands before and after coming into your room. Your doctor will advise you if you need to continue to take antibiotics once you go home.
What do health chiefs advise?
Dr Yimmy Chow, health protection consultant at the UK Health Security Agency (UKHSA), said of the Ealing case: “We are extremely saddened to hear about the death of a child at St John’s Primary School, and our thoughts are with their family, friends and the school community.
“Working with Ealing Council public health team, we have provided precautionary advice to the school community to help prevent further cases and we continue to monitor the situation closely. Group A streptococcal infections usually result in mild illness, and information has been shared with parents and staff about the signs and symptoms.
“These include a sore throat, fever and minor skin infections and can be treated with a full course of antibiotics from the GP. In rare incidences, it can be a severe illness and anyone with high fever, severe muscle aches, pain in one area of the body and unexplained vomiting or diarrhoea should call NHS 111 and seek medical help immediately.”
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