What’s behind the surge in fatal Strep A cases in the UK?

Health officials in the UK have warned that the NHS could struggle to cope with an influx of possible Strep A cases after a seventh child was reported to have died from the infection.

A sharp increase in the number of cases in England and Wales this winter compared to previous years is believed to be linked to a drop in immunity and re-exposure to infection after three years of Covid restrictions.

It has sparked a flurry of headlines that could have a knock-on effect on the already beleaguered health service in the run-up to Christmas, health experts warn.

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What is Strep A?

Streptococcus A, otherwise known as Strep A, is a common bacterium found in the throat and on the skin. Infections are “usually mild”, said the BBC, causing illnesses ranging from sore throats to the more contagious scarlet fever, but in very rare cases can become life-threatening if it gets into the bloodstream.

This form of invasive Group A Streptococcal infection, or iGAS, is “becoming more common, though, again, still rare”, said Sky News, and is “most likely to be the cause of the current deaths”.

“Anyone can get strep, but it is most likely to develop in children, spread through coughing, sneezing, close contact or on surfaces,” said The Sunday Times. “It peaks in winter, when they are together in a confined space, at school or nursery.”

Why is it on the rise?

There were reports on Sunday that a 12-year-old schoolboy from London had become the seventh child since September to die in England and Wales after contracting Strep A. In a typical winter the total is one or two, said The Sunday Times.

It comes amid a steep rise in overall cases. This year, there have been 2.3 cases for every 100,000 children aged between one and four years old, compared to 0.5 per 100,000 before the pandemic. For children aged five to nine, there have been 1.1 cases per 100,000, compared with an average of 0.3 pre-Covid.

With rates of scarlet fever and iGAS now two to three times higher than the same time of year pre-pandemic, and cases occurring earlier in the year, the UK Health Security Agency (UKHSA) issued a rare alert on Friday.

It said there was no evidence that a new strain of Strep A was circulating, with the increase “most likely due to high amounts of circulating bacteria and social mixing”, said The Guardian.

The early start to the Strep A infections season in the UK could be a knock-on effect of the Covid-19 pandemic, with the higher than average rates also linked to a drop in immunity due to lack of exposure to infection as a result of coronavirus restrictions.

How to spot it?

Strep A symptoms include pain when swallowing, fever, skin rashes and swollen tonsils and glands, with infection common in crowded settings such as schools and daycare centres, the US Centers for Disease Control and Prevention (CDC) said on its website.

Parents are being urged to be specifically alert to the symptoms of scarlet fever in their children. These infections normally start with a high temperature, sore throat and headache, followed by a red rash that spreads across the chest, neck and arms.

“The rash can be harder to see on darker skin, or if the child also has chickenpox. But the skin will feel rough, like sandpaper,” said Sky News. “That’s the point to get medical attention because the infection can get worse quite quickly.”

Unusual drowsiness, dehydration and not needing the toilet as much as usual are also particularly concerning symptoms.

The UKHSA has urged doctors to set themselves a “low threshold” for sending children with potential Strep A infections to hospital and prescribing them antibiotics.

Can it be treated?

“This isn’t a geographic cluster; the children lived far apart. So it’s not a bug that was passed from one to another,” said Sky. “It’s more likely that the common link is that the children didn’t get antibiotics in time.”

While there is no vaccine to prevent Strep A or iGAS infections, antibiotics are usually effective at treating them, with Beate Kampmann, professor of paediatric infection, telling the BBC’s Today programme: “The good news is that Group A strep is very, very treatable just with penicillin.”

However, the Birimingham Mail cited Dr Leyla Hannbeck, CEO of the Association of Independent Multiple Pharmacies, who claimed the UK faces a shortfall in the supply of another antibiotic, amoxicillin, “the vital drug used to treat killer winter bug strep A”.

It comes after medical professionals raised concerns about how frontline NHS services will cope with a likely influx of children of concerned parents, and the difficulties of spotting serious cases from minor symptoms.

Neena Modi, professor of neonatal medicine at Imperial College London, said both GP services and A&E departments were “on their knees” and that “the last thing we want is for A&E departments to be flooded with a new influx of worried parents”.