06/12/2022
"STREP A" AND SCARLET FEVER INFECTION - GUIDANCE FROM HERTS CC DIRECTOR OF PUBLIC HEALTH
What is group A Streptococcus (GAS)?
Group A streptococci are bacteria commonly found in the throat and on the skin. The vast majority of GAS infections are relatively mild illnesses, such as strep throat and impetigo. Occasionally, however, these bacteria can cause much more severe and even life threatening diseases. In addition, people may carry group A streptococci in the throat or on the skin and have no symptoms of disease.
How are group A streptococci spread?
These bacteria are spread by direct contact with nose and throat discharges of an infected individual or with infected skin lesions. The risk of spread is greatest when an individual is ill, such as when people have strep throat or an infected wound. Individuals who carry the bacteria but have no symptoms are much less contagious. Treatment of an infected person with an appropriate antibiotic for 24 hours or longer eliminates contagiousness. However, it is important to complete the entire course of antibiotics as prescribed. Household items like plates, cups and toys do not play a major role in disease transmission.
What is Scarlet Fever?
Scarlet fever is an illness that mainly affects children, caused by the same Streptococcus Group A bacterium. It causes a distinctive pink-red rash. Generally, scarlet fever is much less common than it used to be but in recent years there have been a number of significant outbreaks. It’s important to be aware of the signs and symptoms of scarlet fever so that early treatment with antibiotics can be given quickly.
Scarlet fever usually follows a sore throat or a skin infection, such as impetigo, caused by particular strains of streptococcus bacteria.
Initial symptoms usually include a sore throat, headache and a high temperature (38.3C/101F or above), flushed cheeks and a swollen tongue.
A day or two later the characteristic pinkish rash appears. It usually occurs on the chest and stomach before spreading to other areas of the body, such as the ears and neck.
The symptoms of scarlet fever usually develop two to five days after infection, although the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as seven days.
The rash feels like sandpaper to touch and it may be itchy. On darker skin the rash may be more difficult to see although its rough texture should be apparent.
Notifications and GP consultations of scarlet fever are higher than normal for this early point in the season, after remaining elevated later in the previous season than expected.
· What is invasive group A streptococcal disease?
· Invasive GAS disease is a severe and sometimes life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle and fat tissue or the lungs. Two of the most severe, but least common, forms of invasive GAS disease are called necrotizing fasciitis (infection of muscle and fat tissue) and streptococcal toxic shock syndrome (a rapidly progressing infection causing low blood pressure/shock and injury to organs such as the kidneys, liver and lungs). Approximately 20 percent of patients with necrotizing fasciitis and 60 percent with STSS die. About 10-15 percent of patients with other forms of invasive group A streptococcal disease die.
· Please be assured that we [HCC Public Health team] are actively looking for iGAS cases in Hertfordshire to ensure they are fast tracked into treatment
· Notifications of invasive group A streptococcus (iGAS) disease are following a similar trend and are slightly higher than expected for this time of year. The relatively higher rates of iGAS in children are noted and may reflect increases in respiratory viruses.
When should I call for help?
As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. Contact NHS 111 if 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 I prevent it?
There is no vaccine for Strep A. Antibiotics can treat people infected who need treatment
Prevention is via the range of methods of good hygiene and isolation from others if a person is feeling unwell with these symptoms.
