Why is Strep A on the rise? Reason there’s so many cases and deaths among children - what advice is there

At least nine children in the UK have died in recent weeks after contracting Strep A.

Health chiefs are rushing to contain the outbreak, which normally only causes mild symptoms. The UK Health Security Agency (UKHSA) 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.

While Downing Street said it can “fully understand” that parents are concerned by rising Strep A cases, but insisted the NHS is “well prepared”. But why is the infection on the rise and what is the current advice? Here’s what you need to know.

What is Strep A?

Strep A, which refers to Group A Streptococcus (GAS), is the name given to a type of bacteria sometimes found in the throat or on the skin. It usually causes mild illnesses such as a sore throat, but can cause other infections such as pneumonia and scarlet fever.

In very rare occasions, the bacteria can get into the bloodstream and cause an illness called invasive Group A strep (iGAS). While still uncommon, there has been an increase in invasive Group A strep cases this year, particularly in children under 10.

There were 2.3 cases per 100,000 children aged one to four compared to an average of 0.5 in the pre-pandemic seasons (2017 to 2019) and 1.1 cases per 100,000 children aged five to nine compared to the pre-pandemic average of 0.3 (2017 to 2019) at the same time of the year.

Why is Strep A on the rise?

The UKHSA said investigations are underway following reports of an increase in Strep A infections in children over the past few weeks, which have caused severe illness.

There is currently no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria, said the UKHSA.

“It isn’t possible to say for certain what is causing higher than usual rates of these infections. There is likely a combination of factors, including increased social mixing compared to the previous years as well as increases in other respiratory viruses,” added the UKHSA.

Martin Michaelis, professor of molecular medicine at the University of Kent, said: “It is really difficult to tell why Strep A infections appear to be on the rise. Some people argue that this has been caused by a lack of exposure, which has resulted in reduced immune protection.”

He added: “It is clear that the Covid-19 pandemic has interrupted the transmission patterns of many infectious diseases. However, it is currently just an assumption that this may have resulted in increased vulnerability to a range of other pathogens that we would normally be regularly exposed to.”

Prof Michaelis said some have reported that Strep A infections had already been on the rise pre-Covid, with other findings suggesting that Covid may interact with and promote Strep A infections.  It is therefore “impossible to know exactly what is going on” at this moment in time, he added.

He explained that the Covid pandemic and the Strep A infections have “clearly exposed our knowledge gaps” when it comes to the spread of infectious diseases. “More research is needed to develop a better understanding of the dynamics underlying the transmission patterns of pathogens and the factors that determine the severity of diseases caused by them,” Prof Michaelis added.

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.”

What symptoms should be looked out for?

Strep A can cause throat infection, scarlet fever or skin infections such as cellulitis or impetigo. These infections are usually treated with antibiotics, but 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.

The symptoms of invasive disease can include: :

• fever (a high temperature above 38°C (100.4°F)
• severe muscle aches
• localised muscle tenderness
• redness at the site of a wound

Contact NHS 111 or your GP if:

• your child is getting worse
• your child is feeding or eating much less than normal
• your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
• your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
• your baby feels hotter than usual when you touch their back or chest, or feels sweaty
• your child is very tired or irritable

Call 999 or go to A&E if:

• your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• there are pauses when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake

How can we stop infections from spreading?

The UKHSA explained that good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap and warm water for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up, or spreading, infections.