Experts last night provided an essential briefing on Group A Strep (Streptococcus pyogenes) to healthcare professionals, amid an outbreak of infections in the UK.
Hosted by the Royal Society of Medicine, the Spotlight on Group A Strep webinar on Wednesday 14 December 2022 covered recent deaths, diagnosis and treatment of scarlet fever and its complications, the crucial role of parents, and concerns over antibiotics.
Strep A infections are common every year in the UK and most cases are mild. There is no evidence that this year’s infections are caused by a more virulent or deadly strain - the main difference is that the outbreak has occurred earlier than usual. Strep A infections occur more commonly in children because they have had limited exposure to the Strep bacteria and the panel speculated whether the lack of social mixing during the COVID-19 pandemic years might have exacerbated this. Adults are “much less of a risk”, said Professor Susan Hopkins, Chief Medical Advisor at the UK Health Security Agency (UKHSA), because they have usually had repeated exposure.
Parents were advised to familiarise themselves with the symptoms of scarlet fever, which are described on the NHS website: “The first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck). A rash appears 12 to 48 hours later. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper.”
Empowering parents to spot when to worry about their child’s symptoms is crucial, the panel agreed. Dr Elizabeth Whittaker, a consultant in paediatric infectious diseases at St Mary’s Hospital London, said: “There's a huge number of ‘worried well’ parents who, not unreasonably, are concerned because of the reporting of deaths.”
Parents should “worry when they would usually worry”, she suggested, and recommended this YouTube video by paediatrician Dr Damien Roland as a good source of information on what parents should look out for. Letting parents observe how you are examining their child, so they can replicate it at home, can be a useful tool, added Professor Hopkins.
Professor Adam Finn, professor of paediatrics at the University of Bristol, added that “clinicians are very experienced in this country at judging when and when not to give antibiotics.” This has also been highlighted in a clinical guideline from NICE.
If appropriate, antibiotics will usually be a very effective treatment of Strep A infections, generally having an impact after 24 hours. But Dr Whittaker warned: “We have to make sure that parents understand that [children] can still get sick on antibiotics.”
While rare, severe complications can come on very rapidly, sometimes after a child has been examined and sent home by a doctor. Helping parents understand when to return is vital. Professor Finn said: “It is important to let parents know that being sent home does not mean your child is now cured and doesn't need to be seen again. We need to help people recognise that, if things do deteriorate, they need to come back urgently. That is the key to trying to avoid severe cases and potential death.”
Much has been made in the press of the lack of antibiotics to treat Group A Strep. Professor Hopkins said that there had been a fivefold rise in demand for penicillin – the preferred antibiotic for treating Group A Strep in children – in recent weeks but this was no cause for alarm.
There are plenty of alternatives to penicillin, reassured Professor Finn: “There are an abundance of antibiotics that one can use to treat this particular infection.”
Crushing up tablets into peanut butter or chocolate spread is a good alternative if antibiotics in suspension form are in short supply, the panel said.
On the media coverage of recent deaths, Professor Hopkins said that the UKHSA was doing a “deep dive” to understand why some children become more severely unwell. But she emphasised that a very small number of deaths is sadly to be expected with this infection. Professor Finn urged for balanced reporting. He said: “People need to be aware of the problem, but they should not be pushed into this enormous state of anxiety, which we're seeing at the moment.”
As to when the outbreak might end, Professor Hopkins was cautious. She said: “School holidays will provide a natural break, so the high levels of social mixing between children is likely to be less from this Friday.
“But, given there's a higher number of susceptible children out there, I wouldn't be surprised if we saw more cases in January.
“We have to be prepared that we may see a very long wave as this infection circulates amongst the children who have not seen it for the last few years.”
The webinar was chaired by Professor Gillian Leng, Dean of Education at the Royal Society of Medicine.