Doctors are being urged to act quickly in giving antibiotics to children with suspected Strep A symptoms to give them the best chance of fighting off the infection.
UK Health Security Agency (UKHSA) bosses have issued an urgent public health alert to GPs telling them to set a “low threshold” for sending children with possible infections to hospital and providing medication early.
The alert has been sent to all GPs, urgent care centres, A&Es and paediatric and infectious disease services following a rising concern about the number of infections. It reminds doctors to notify public health teams quickly about cases so they can begin contact tracing.
The UKHSA said there has been a rise in rare invasive Group A strep this year, particularly in children under the age of 10, with five deaths of under-10s in England since September.
A separate case has been reported in Wales and now a 12-year-old attending a school in south London has become the seventh fatality after suffering complications stemming from Strep A, according to reports.
There have been 2.3 cases of Strep A per 100,000 children aged between one and four this year in England, compared with an average of 0.5 before the pandemic. There have also been 1.1 cases per 100,000 children aged five to nine compared with the pre-pandemic average of 0.3.
The UKHSA letter says: “Given the unusually high level of GAS (group A strep) and viral co-circulation in the community, health care professionals are asked to have a low threshold to consider and empirically prescribe antibiotics to children presenting with features of GAS infection, including where secondary to viral respiratory illness.” It adds that parents of children with what appear to be viral infections, such as flu or chickenpox, should be told about signs that could suggest “secondary bacterial infection”.
The warning from health bosses comes as the father of a four-year-old girl on a ventilator with a Strep A infection said she was described as “the poorliest girl in the whole of England”.
Camila Rose Burns, from Bolton, is “fighting for her life” while her family has been “living in an absolute nightmare” since she was admitted to Liverpool’s Alder Hey Children’s Hospital last Sunday - 24 hours after she was sent away from A&E with an inhaler when doctors put her chest pains down to retching from vomiting repeatedly.
Dean Burns said there was a sickness bug going around his daughter’s school and she complained about her chest hurting. Camila was taken to hospital last Saturday (26 November) where she was prescribed an inhaler and told she could go home, but her health deteriorated a day later.
Mr Burns said his daughter’s went from dancing on Friday night with her friends to feeling “a little bit under the weather on Saturday” and needing emergency care on Monday. He told Sky News: “She just completely changed. She was restless.” After being taken back to hospital, Camila needed life-saving intervention.
Mr Burns added: “We shouted some nurses down and we had to leave the room. They put her to sleep and she’s been on a ventilator ever since, keeping her alive. It’s the worst thing that can ever happen to anybody.”
What is Strep A infection?
Group A strep bacteria can cause many different infections, ranging from minor illnesses to deadly diseases, including the skin infection impetigo, scarlet fever and strep throat.
The vast majority of infections are relatively mild but sometimes the bacteria causes a life-threatening illness called invasive Group A Streptococcal disease after spreading to other 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, while 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.
Dr Colin Brown, Deputy Director, UKHSA, said: “We are seeing a higher number of cases of Group A strep this year than usual. The bacteria usually causes a mild infection producing sore throats or scarlet fever that can be easily treated with antibiotics.
“In very rare circumstances, this bacteria can get into the bloodstream and cause serious illness – called invasive Group A strep (iGAS). This is still uncommon; however, it is important that parents are on the lookout for symptoms and see a doctor as quickly as possible so that their child can be treated and we can stop the infection becoming serious.
“Make sure you talk to a health professional if your child is showing signs of deteriorating after a bout of scarlet fever, a sore throat, or a respiratory infection.”
Advice for parents
Health officials are urging parents to contact NHS 111 or their GP if their child is getting worse, is feeding or eating much less than normal, has had a dry nappy for 12 hours or more or shows other signs of dehydration.
They should also seek help if their baby is under three months and has a temperature of 38C, or is older than three months with a temperature of 39C or higher. A very tired or irritable child is also a red flag.
If a child is having difficulty breathing, such as by making grunting noises or sucking their stomach in under their ribs, or pauses in breathing, has blue skin, tongue or lips, or is floppy and unresponsive, parents should call 999 or go to A&E.