What is Strep A and which symptoms should you be looking for?

Nine children have died with an invasive form of the Strep A bacterial infection in recent months but what exactly is the bacteria and when should you be worried?

It's a very common bacteria, but it can lead to deadly infections, although these are rare and most can be successfully treated with anti-biotics.

Recently there has been a rise in infections caused by the Strep A bacteria and some of those cases have lead to more serious infections.

The latest death is a five-year-old boy in Belfast who attended a Belfast primary school, where last week a severe case of Strep A was reported.

Illnesses caused by the Group A strep bacteria include skin infection impetigo, scarlet fever and strep throat.

Here's what we know about Strep A and what you should be looking out for:

What is Strep A?

Group A Streptococcus (Group A Strep or Strep A) is a very common bacteria but it can cause many different infections.

The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.

Infections cause by Strep A range from minor illnesses to serious and deadly diseases.

They include the skin infection impetigo, scarlet fever and strep throat.

While the vast majority of infections are relatively mild, sometimes the bacteria cause life-threatening illness called invasive Group A Streptococcal disease.

How is Strep A spread?

The Strep A bacteria are spread by contact with an infected person or by contact with infected skin lesions.

Bacteria can be passed from person to person by close contact such as kissing or skin contact or through coughs and sneezes

The risk of spread is greatest when somebody is ill, such as when people have strep throat or an infected wound.

Which infections does GAS cause?

GAS causes infections in the skin, soft tissue and respiratory tract. It’s responsible for infections such as tonsillitis, pharyngitis, scarlet fever, impetigo and cellulitis among others.

While infections like these can be unpleasant, they rarely become serious. When treated with antibiotics, an unwell person with a mild illness like tonsilitis stops being contagious around 24 hours after starting their medication.

Scarlet Fever

There have been a big leap in the number of scarlet fever cases.

There were 851 cases reported in the week November 14 to 20, compared to an average of 186 for the same timeframe in previous years.

Symptoms of scarlet fever include sore throat, headache, and fever, along with a fine, pinkish or red body rash with a “sandpapery” feel.

On darker skin the rash can be more difficult to detect visually but will have a “sandpapery” feel.

If a parent or carer suspects scarlet fever they should call their GP or 111 as prompt treatment with antibiotics can prevent serious illness and stop the spread of infection.

What is 'invasive Group A Streptococcal disease'?

Invasive Group A Strep disease is sometimes a life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle or lungs.

Two of the most severe, but rare, forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.

Necrotising fasciitis is also known as the “flesh-eating disease” and can occur if a wound gets infected.

Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure/shock and damage to organs such as the kidneys, liver and lungs.

This type of toxic shock has a high death rate.

Can these Strep A illnesses be treated?

Strep A infections such as scarlet fever and impetigo are treated with antibiotics.

After a full 24 hours of antibiotics, people are generally thought to no longer be contagious.

Anyone thought to have invasive Group A Streptococcal disease should seek medical help immediately. Antibiotics, other drugs and intensive medical attention are likely to be needed.

When should I see a doctor about Strep A?

Strep throat is different from a regular sore throat and the pain can come on very quickly.

Symptoms include pain when swallowing, fever, and red and swollen tonsils – sometimes with white patches or streaks of pus.

The NHS recommends people see their GP if a sore throat does not improve after a week, if they are worried or if they have a high temperature, or feel hot and shivery.

People with weakened immune systems such as those having chemotherapy should also see a doctor.

Impetigo is a skin infection which starts with red sores or blisters that then burst, leaving crusty, golden patches. The infection can be treated with antibiotics.

Scarlet fever symptoms are often flu-like, including a high temperature, a sore throat and swollen neck glands.

A rash appears 12 to 48 hours later, starting on the chest and stomach and then spreading.

A white coating also appears on the tongue which peels, leaving the tongue red, swollen and covered in little bumps (often called “strawberry tongue”).

Signs of necrotising fasciitis include fever (a high temperature above 38C), severe pain and swelling, and redness at the wound site.

Early signs and symptoms of toxic shock may include fever, dizziness, confusion, low blood pressure, rash and abdominal pain.

What is being done to investigate the rise in cases in children?

The UK Health Security Agency (UKHSA) says that investigations are underway following reports of an increase in lower respiratory tract Group A Strep infections in children over the past few weeks, which have caused severe illness.

Currently, there is no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria.

It isn’t possible to say for certain what is causing higher than usual rates of these infections. There is likely a combination of factors, including increased social mixing compared to the previous years as well as increases in other respiratory viruses.

What should parents look out for?

GAS infections cause various symptoms such as sore throat, fever, chills and muscle aches.

The UKHSA says that 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 we stop infections from spreading?

Good hand and respiratory hygiene are important for stopping the spread of many bugs.

By teaching your child how to wash their hands properly with soap and warm water for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up, or spreading, infections.

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