Strep A: preventative antibiotics to be given to groups of children during outbreaks after ninth UK death

Children at primary schools affected by the Strep A outbreak are to be given antibiotics as a prevention measure, health officials have confirmed.

The UK Health Security Agency (UKHASA) said local health teams will be able to prescribe penicillin or an alternative antibiotic to all children in a year group that has been hit by a case of the infection, even if they do not have symptoms.

The health agency said the measure of prescribing antibiotics to children in a school or nursery exposed to non-invasive Strep A was “rare”, and is only considered in “exceptional circumstances” by the Outbreak Control Team (OCT) on a “case-by-case basis”.

Deputy director of the UKHSA Dr Colin Brown told Sky News there was “long-standing guidance” that enables health protection teams to assess the situation in schools and nurseries to consider antibiotic prophylaxis for “either a group of children in certain classes or an entire nursery school”.

He also reiterated there is no evidence to suggest there has been a change to the circulating strains of Strep A to make them more severe, following the deaths of at least nine children across the UK.

A five-year-old child who attended Black Mountain Primary School in Belfast has been confirmed as the latest death. Parents of the youngest pupils at the school received a letter from the Public Health Agency on Friday (2 December) to tell them a pupil had been diagnosed with a severe form of Strep A and the child’s death was confirmed on Tuesday morning (6 December). The school spoke of its “tragic loss” and said “the thoughts of the entire school are with the pupil’s family and friends at this difficult time”.

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 a 12-year-old attending a school in south London became the seventh fatality after suffering complications stemming from Strep A, according to reports. An eighth child, reportedly a pupil at Morelands Primary, in Waterlooville, Hampshire, is believed to have died with an invasive form of the Strep A bacteria.

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.

‘Lack of social mixing fuelling cases’

Dr Brown suggested that a lack of social mixing due to the Covid pandemic, plus susceptibility in children, are likely “bringing forward the normal scarlet fever season” from spring to this side of Christmas.

He said: “There isn’t something that is particularly new or novel about the bacteria that are causing the infections that we’re seeing at the moment. We are seeing a larger number of infections, for example, causing scarlet fever, than we would normally see this time of year.”

There has been a big leap in the number of scarlet fever cases this year, with 851 cases reported from 14 to 20 November, compared to an average of 186 for the same period in previous years. Symptoms typically include sore throat, headache and fever, and a fine, pinkish or red body rash may develop with a “sandpapery” feel.

Updated guidance on scarlet fever outbreaks, which are caused by Strep A, published by the UKHSA in October sets out how antibiotics can be used as prophylaxis but a decision is taken with local outbreak control teams (OCTs) on “a case-by-case basis”.

Group A strep bacteria can cause many different infections, including the skin infection impetigo, scarlet fever and strep throat, but in some cases it can develop into a more serious invasive Group A Strep (iGAS) infection, although this is rare.

Health officials have noticed an increase in iGAS cases this year, particularly in children under the age of 10. Online NHS information suggests Strep A infections, such as scarlet fever, can be treated with the antibiotics penicillin and amoxicillin.

Downing Street said it can “fully understand” that parents are concerned by rising Strep A cases, but stressed the NHS is “well prepared” for such situations.

The Prime Minister’s official spokesman said: “We are seeing a higher number of cases of Group A strep this year compared to usual. The bacteria we know causes a mild infection which is easily treated with antibiotics and in rare circumstances it can get into the bloodstream and cause serious illness.

“It is still uncommon but it’s important parents are on the lookout for symptoms. But the NHS is well prepared to deal with situations like this, working with the UK Health Security Agency.”

When to call 999

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.