The UK Health Security Agency (UKHSA) report that streptococcal (Strep) A infection are at their highest levels over the past five years. Fifteen children in the UK have died after invasive strep A infections since September. These are the most recent figures from the UK Health Security Agency. The death of one child was in Wales and one in Northern Ireland. There have been no confirmed deaths in Scotland so far. There have also been 47 deaths from strep A in adults in England.
UKSA reports that A Strep bacteria may, albeit rarely, cause scarlet fever or get into the bloodstream and cause a condition known as invasive Group A streptococcal infection (iGAS); iGAS can be fatal.
The UK Health Security Agency reports increases in both scarlet fever and IGAS in the UK including the North East of England.
Numbers of Strep A infections
In the UK, in the week ending December 4 there were 1131 cases of scarlet fever. The week before there were 991 and the week before that 950. These figures have quadrupled for this time of year. In the North East, there were 59 cases of scarlet fever in the seven days to December 4 and 34 the week before that. County Durham had 28 cases during that time. There were 16 in Redcar and Cleveland,13 in Middlesbrough and 12 in Northumberland. There have also been cases in Newcastle (8), Gateshead (2), North Tyneside (5), Sunderland (4), Hartlepool (2), Darlington (1) and Stockton-on-Tees (2). In the same fortnight period, there has been just one case of IGAS in our region. However, it has been recorded around the country with 18 cases nationwide.
The North East and North Cumbria NHS symptom checker
“We want parents to know what to look out for and when to seek medical care. Use our links to check if your child has any ‘red flag symptoms’, if not they are probably safe to be cared for at home.”
This resource was created by paediatric consultants at the Great North Children’s hospital in Newcastle upon Tyne (GNCH).
For The North East and North Cumbria NHS symptom checker click here.
Schools minister Nick Gibb has said preventative antibiotics could be given to children at schools affected by Strep A infections. He said the UK Health and Security Agency is monitoring the position.
High rates of strep A reporting
The story of the increased numbers of strep A infections is getting much interest in newspapers and in scientific literature.
Dr Helen Salisbury, chief medical officer at UKHSA writes in the British Medical journal, discussing the importance of safety netting. It is not always easy to pick out the child with a sore throat whose health will suddenly worsen, from those who will recover quickly with paracetamol. Effective safety netting means that the patient/parent or carer knows what the expected course of recovery should be and what might be cause for concern. The message Dr Salisbury believes would be the most useful for GPs to provide would be:
“I expect this sore throat to improve over the next five days, but we need to see your child again straight away if they develop a rash, are unable to eat and drink, or become unusually tired or irritable.”
Reduced childhood infections during the pandemic.
Seilesh Kadambari, and the Oxford vaccine group, published findings of reduced numbers of childhood infections during the pandemic in the British Medical Journal. The group evaluated hospital admissions for child data from every NHS hospital in England from 1 March 2017 to 30 June 2021. Similar findings have been reported in Australia, Denmark, France, and the Netherlands. Cases of common childhood infections were reported to have reduced by more than 50%. During the covid-19 pandemic, changes in behaviour including social distancing, wearing masks, reduced travel as well as school closures, and minimal recreational activities. Such measures that reduced transmission of Covid-19, also reduced admissions for common and severe childhood infections.
Increased childhood infections after the pandemic.
In contrast, after the pandemic behaviour has largely reversed back to hugs, kisses, reduction in wearing masks, recreation, and travel. Childhood infections have increased, dramatically. The bug streptococcus would have always been around and some children and adults would have been carriers. After lockdown and the end of social distancing the bugs find hosts galore. Some children and adults would have greater vulnerabilities to their immune system than others, due to a multitude of reasons; they become infected.
The reasons for different immune system responses would be attributed to a multitude of factors, to Covid-19, changing the status of social interaction, to travel, to changes in frequency visiting GPs. Dr Devi Sridhar, chair of global public health at the University of Edinburgh and Guardian columnist reminded me in her writing that it is too early to determine specific causes for the increase in strep A cases.
The scientific process involves waiting for clear data, then analysing and testing these data against different hypotheses. She speculates that the amount of attention given to the increase in cases is the rush to fit the increase in strep throat to pre-existing narratives whether motivated politically or motivated by other agendas. Those opposed to wearing masks or social distancing might argue that these measures caused the post pandemic increase in strep throat cases. Others suggest a weakened immune system subsequent to Covid-19 infection. No suggestion is proven.
Dr Sridhar, so importantly, reminds us:
“In 2020, 789 child deaths were recorded in England and Wales, which was the lowest on record, with 11 of those caused by Covid-19. Most deaths in children are due to cancer, accidents such as injuries and poisonings, and congenital conditions….while strep A is obviously concerning, we have the knowledge and tools to manage the disease and prevent more deaths.”
Finally, the UK Health Security Agency. UKHSA update on scarlet fever and invasive Group A strep, 2 Dec 2022, suggest that the increase is most likely related to high amounts of circulating bacteria and social mixing.