Strep A – what you should know beyond the headlines

You will have read the news stories currently dominating headlines about scarlet fever and Strep A, and that a number of children in the UK have recently died of complications relating to a particularly aggressive form of Strep A called invasive Group A strep (iGAS). 

Our thoughts are with the families of the children who have died.  

We know as a parent you will be concerned, so we’ve done the research for you and gathered information here from only the most reliable sources, to keep you informed. 

In the following content, we explain a bit more about this illness and associated symptoms, along with recommended action from health professionals and current advice on the use of antibiotics.  

But the most important thing to come away with is the confidence to trust your instinct as a parent. You are (always) the expert in your own child.  

If you feel your child needs medical attention, especially if an illness is getting worse or not improving over time, don’t feel put off from seeking help. It can go against our nature to push back against medical professionals, but don’t be afraid to be that bit pushier than you would usually be if you feel something is wrong.  

In the UK, we are lucky to have options when it comes to seeking help, although we know at the moment it can be hard to get an appointment with your GP; if you are concerned and can’t get through to make an appointment, call 111 for advice. If you feel it is too urgent to wait, go to your local urgent care or A&E department.  

Scroll down for clear instructions from the UK Health Security Agency on who to contact and when in the case of Strep A type symptoms.  

Most of the time, cases of Strep A are mild and can be treated by your GP. This current increase in cases means your doctor will very likely already be on alert for Strep A.   

If you see a doctor and you feel they need to check for Strep A, please don’t feel too shy to ask them to test for it specifically. The symptoms are similar to many other winter illnesses, so a test is the best way to get peace of mind.  

It is highly contagious, so keeping ill children away from others until treatment has started and they feel better is very important. For all children, make sure thorough handwashing is part of your daily routine to reduce the risk of illness.  

A little bit about Strep A – what you need to know 

Strep A is the name being used in the news to talk about this illness, and although they’re not wrong to call it this, it helps us as parents to understand what we are looking for to have a better knowledge of the illness.  

There are several illnesses all caused by bacteria called group A streptococci (sometimes called Strep A for short). These include tonsilitis, scarlet fever, sore throats, impetigo, pneumonia and other respiratory and skin infections.  

We have highlighted scarlet fever symptoms below, and if you want to find out more about any of these illnesses, we recommend looking them up on the NHS website which is a great source of information. 

In rare but serious cases, Strep A can get into the bloodstream causing invasive Group A strep (iGAS). iGAS is still uncommon, but part of the reason news outlets are picking up on the story now is that (like with scarlet fever) cases are higher than previous years. Symptoms of iGAS are listed below.  

Why is this in the news now? The increase in cases 

This year, cases of scarlet fever being reported in the UK are higher than in previous years.[1]  

Along with this increase in scarlet fever, which indicates there are more infections caused by Strep A circulating, there are more cases than we would usually expect to see (especially at this time of year) of the serious illness iGAS. 

According to the UK Health Security Agency: “There were 2.3 cases [of iGAS] per 100,000 children aged 1 to 4 compared to an average of 0.5 in the pre-pandemic seasons (2017 to 2019), and 1.1 cases per 100,000 children aged 5 to 9 compared to the pre-pandemic average of 0.3 (2017 to 2019) at the same time of the year.”[1] 

We don’t yet know why it is circulating more widely – it may be due to changes in how illnesses are being spread post-lockdown, but more research is needed before we can truly know why. 

What to look out for, and what to do if you’re worried 

Strep A symptoms can be varied and similar to other winter illnesses, adding to the worry for parents as we find ourselves trying to work out the difference between a cold, COVID, RSV and now Strep A illnesses.  

The most important thing to remember is that it is not your job to diagnose what’s wrong – only to know that something is not right for your child, and to seek help.  

If it turns out that your child is unwell with something else, perhaps a winter cold, you won’t have wasted anyone’s time or done the wrong thing. Following your gut and seeking help is exactly what the health system is here for, and it is always better to be sure.  

Scarlet fever symptoms 

The symptoms of scarlet fever include headaches, a sore throat, a bright pink ‘strawberry tongue’, and fever. Children may also get a fine, pinkish or red rash with a sandpapery feel. On darker skin, the rash can be harder to see but will have a sandpapery feel.  

Contact NHS 111 or your GP if you suspect your child has scarlet fever, as early treatment can be important when fighting this illness and to stop it spreading.  

Other illnesses caused by Strep A bacteria are harder to identify, and will often need tests to positively identify. The UK Health Security Agency has issued this advice for families: 

“As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. 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 38°C, or is older than 3 months and has a temperature of 39°C 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”[1] 

iGAS symptoms 

Although uncommon, it helps to feel confident knowing what to look for when it comes to the more severe iGAS symptoms.  

As well as the symptoms and actions listed above, if there are signs that your child is becoming more unwell after showing symptoms you should seek medical help quickly. This is especially true if they have been in contact with anyone you know has had a Strep A related illness recently.[2] 

If your child has any of these symptoms, seek emergency medical treatment, such as going to A&E: 

• a high temperature that is not improving (especially after usual treatments for fever) 
• difficulty breathing 
• are more lethargic and irritable than usual 
• severe muscle aches or sore joints (your child may show this by not wanting to move an arm or leg, or not being able to move comfortably) 
• have a new or changing rash that does not disappear when a glass is pressed over it 
• vomiting a lot, or unexplained vomiting 
• showing signs of dehydration  

Above all, know that in most cases illness caused by Strep A bacteria can be treated and is not life-threatening. Knowing the signs and symptoms, and getting treatment as quickly as possible, will make a difference if anyone in your family does become unwell.  

Antibiotics as prevention? What you need to know about the news surrounding this suggestion 

On Tuesday 6th December 2022, many news sites have led with headlines about the possible use of antibiotics as a preventative measure to protect against Strep A infection.  

This comes after schools minister Nick Gibb told GB News that this option was being considered by the UKHSA.  

He suggested that in schools with known cases, all children who were exposed to a case may be given the antibiotics, and that this would be a decision made by the UKHSA who are monitoring the situation.  

The UKHSA has responded with a statement to the Press Association news agency in which they clarified that giving out antibiotics like this would be “rare” and only considered in “exceptional circumstances” by the Outbreak Control Team (OCT). 

The UKHSA went on to explain that, “There is no good evidence of [antibiotics’] effectiveness in routine outbreak control in this setting (involving children who have been contacts of non-invasive strep A),”  

“It can be considered in exceptional circumstances by the OCT, for example, when there are reports of severe outcomes, or hospitalisations. In school and nursery settings, antibiotic chemoprophylaxis is not routinely recommended for contacts of non-invasive (group A streptococcus) GAS infection.” 

Why not give the medicine out just in case?  

One of the biggest concerns here would be the risk of antibiotic resistance. If a large amount of people takes antibiotics to treat an illness, that illness can (over time) be clever enough to evolve in a way which means those antibiotics will no longer work to treat it.  

For this reason, it is very unusual to hear of a mass prescription of antibiotics, like the one being discussed here.  

Medical professionals, including the UKHSA, would be likely to look for other options to contain an outbreak before prescribing antibiotics as a preventative measure, although if needed the OCT will be able to prescribe them for an outbreak on a case-by-case basis.  

We will, of course, keep a close eye on what the UKHSA decides over the coming weeks and update you as we learn more.  

Should I give my child antibiotics if I have some to hand? 

No. If your child has been prescribed antibiotics by a doctor, they should take the complete course as the doctor instructs.  

Do not give your child antibiotics that were prescribed for someone else, or for another illness, and don’t give them any left-over antibiotics from previous illnesses.  

It is important, for the prevention of antibiotic resistance and to make sure you child feels 100% better, that antibiotics courses are fully completed. Old or unused medications can be dropped off at your local pharmacy to be destroyed.   

We will be updating the advice for this illness here in the app over the coming weeks, to ensure you have only the most scientifically accurate information at your fingertips.  

References: 

[1] UK Health Security Agency ‘Press release: UKHSA update on scarlet fever and invasive Group A strep.’ Published online 2nd December 2022. Available at: https://www.gov.uk/government/news/ukhsa-update-on-scarlet-fever-and-invasive-group-a-strep 

[2] Science Media Centre ‘Expert reaction to UK Group A Strep outbreaks’ Published online 2nd December 2022. Available at: https://www.sciencemediacentre.org/expert-reaction-to-uk-strep-a-outbreaks/