Child deaths from Group A Strep

Group A strep bacterium causes scarlet fever, which has caused nine UK child deaths this season.


Most likely

Respiratory viral infections

Group A streptococcus

Invasive Group A streptococcus

https://what0-18.nhs.uk

Currently high rates in the UK

https://www.gov.uk/government/news/ukhsa-update-on-scarlet-fever-and-invasive-group-a-strep

Higher than normal for the time of year

UK, Notifiable diseases

https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report#list-of-notifiable-diseases

Week 46, (W/E 19th November) 851 reported cases

(Average is 186 cases)

Close contact, droplets, hands, food

Incubation, 2 to 5 days

Most common, 2 years to 8 years

90% under 10 years

Typically lasts for 7 – 10 days

Rash disappearing in 7 to 10 days

Should ne immune for decades or life

Invasive Group A strep (iGAS)

Rare occasions,

bacteria get into the bloodstream

More cases of iGAS,

particularly in children under 10

Scarlet fever

Caused by the bacteria Group A streptococcus

Usually a mild illness

Highly infectious

At increased risk

Elderly

Immunocompromised

Clinical features

Sore throat/tonsillitis

Headache

Fever (temperature of 38°C (100.4°F) or above

Painful, swollen glands in the neck

A red tongue (strawberry tongue)

Rash of scarlet fever

Starts 12 to 48 hours after symptoms

Often begins with small spots on the body,

then spread to the neck, arms and legs over the next 1-2 days.

Fine, pinkish or red body rash

It is often 'sand-paper' like to touch (but not itchy)

Darker skin, rash more difficult to see

Sandpapery feel

Diagnosis of scarlet fever / Group A strep less likely

Child who also has a runny nose with their tonsillitis

Antibiotics

Reduce the chance of infection becoming more severe

Stop spread of infection

Penicillin V

Amoxicillin

(Plenty in the UK)

10 days

Finish the course

Home until at least 24 hours after the starting

Possible complications

Occasionally, Group A streptococcus can spread to other areas of the body,

Tonsillar abscesses

Neck lymph node abscesses

Chest infections (pneumonia)

Bone and joint infections (spetic arthritis)

Sepsis

Red warning signs

Pale, mottled and feels abnormally cold to touch

Difficulty breathing, grunting noises, indrawing

Cyanosis, skin, tongue, lips

Has a fit/seizure

Is extremely agitated

Non blanching rash

Child is floppy and will not wake up or stay awake

Amber signs

Rapid breathing

Unable to swallow saliva

Features suggestive of scarlet fever

Seems dehydrated, dry nappy

Drowsy or irritable

Shivering or complains of muscle pain

Painful, swollen gland in the neck

Baby is under 3 months and has a temperature of 38°C / 100.4 °F

Baby feels hotter than usual or feels sweaty

Is 3-6 months temperature of 39°C / 102.2°F or above

Continues to have a fever of 38°C or above, more than 5 days

Child has recently had scarlet fever

Puffy face/eyelids (renal involvement)

Tea 'coca-cola' coloured urine

Swollen, painful joint(s)

Is getting worse or if parents are worried

In the week or two after recovering from scarlet fever

Post streptococcal glomerulonephritis

Post-streptococcal arthritis

Later

Rheumatic heart disease

Is this a new strain?

High amounts of circulating bacteria

Social indoor mixing

Is this a post lockdown effect?