GPs say parents need clearer strep A advice

Posted: 9th December 2022

Source: BBC News

GP leaders have urged the government to put out clearer advice for parents about when to seek help over potential strep A infections.

Prof Kamila Hawthorne, of the Royal College of GPs, said many surgeries were struggling with the extra demand on top of existing pressures.

The government should consider “overspill” services for surgeries unable to cope, she said.

Since September, 15 UK children have died after invasive strep A infections.

This includes the death of one child in Wales, and one in Northern Ireland. There have been no deaths confirmed in Scotland.

The UK Health Security Agency figures (UKHSA) show there have also been 47 deaths from strep A in adults in England.

Most strep A infections are mild, but more severe invasive cases – while still rare – are rising.

Prof Hawthorne, said: “We do not want to discourage patients who are worried about their children to seek medical attention, particularly given the current circumstances.

“But we do want to see good public health messaging across the UK, making it clear to parents when they should seek help and the different care options available to them – as well as when they don’t need to seek medical attention.”

Normally, mild strep A infections cause symptoms like a sore throat or skin infections.

The bug can also cause scarlet fever – with a sore throat, skin rash that feels like sandpaper, a high temperature and a so-called “strawberry tongue”.

‘Early rise’

It is treated with antibiotics which may also help reduce the risk of complications and spread of the bug.

However, in a very small number of cases, strep A can get deeper into the body – for example, into the lungs and bloodstream – causing invasive Group A Streptococcus (iGAS), which needs immediate medical attention.

There can be a range of symptoms at this point, as the body battles an invasive infection, including persistent high fevers, poor appetite, dehydration, altered behaviour and feeling very sleepy,

Strep A infections tend to increase in the winter and peak in the spring, but figures show cases are rising earlier than usual this year.

The UKHSA says the last time there was a significant number of cases was in the 2017/18 season, when there were 27 deaths in children under 18 and 328 adult deaths in England.

Seasons with high cases can occur every three to four years. But social distancing measures during the pandemic may have interrupted the cycle and that could help explain the recent increase, health officials say.

So far, since September, there have been 85 cases of invasive strep A in children aged one to four in England and 60 in children aged five to nine.

The majority of cases are in people over 45.

Dr Colin Brown, deputy director of the UKHSA, said: “We know that this is concerning for parents, but I want to stress that while we are seeing an increase in cases in children, this remains very uncommon.

“There a lots of winter bugs circulating that can make your child feel unwell, that mostly aren’t cause for alarm.

“However, make sure you talk to a health professional if your child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection – look out for signs such as a fever that won’t go down, dehydration, extreme tiredness and difficulty breathing.”

UKHSA experts say there is currently no evidence of a new strain of strep A circulating.

What should parents do?

Trust your judgement if your child seems seriously unwell.

Contact NHS 111 or your local surgery if they:

  • are getting worse
  • are eating much less than normal
  • show signs of dehydration, such as a dry nappy for 12 hours
  • have a temperature of 39C or higher, or 38C if under three months old
  • are a baby and feel hotter than usual when you touch their back or chest or sweaty
  • are very tired or irritable

Call 999 or go to an accident-and-emergency unit if:

  • they are having difficulty breathing – you may notice grunting noises or their stomach sucking under their ribs
  • they are pausing when they breathe
  • their skin, tongue or lips are blue
  • they are floppy and will not wake up or stay awake
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