A rise in cases of strep A and scarlet fever is causing concern for parents and the general public. But when do we need to worry? Anna Bartter asks the experts.
You don’t have to look far in the news this week to find tragic stories of children dying from the bacterial throat infection strep A, which is circulating in country. It’s safe to say that following the Covid-19 pandemic, we’re all on edge when it comes to infectious illnesses, especially ones which are highly contagious.
We asked the experts for the lowdown on strep A, when to be concerned and how to know if you have a simple cold, strep A or Covid infection.
What is strep A?
“Strep A is a type of bacterium found in the throat and on the skin,” explains GP and director of Cosmedics Dr Ross Perry. “Group A streptococcus (GAS) is a common bacterium that lots of us carry it in our throats and on our skin and it doesn’t always result in illness.”
So why the focus on it? Well, the concern is two-fold. Firstly, strep A bacteria can lead to more serious infections in rare cases.
Pharmacist Duncan Reid explains: “Streptococcus A (strep A) are a group of bacteria that cause scarlet fever and respiratory and skin infections such as strep throat and impetigo. Scarlet fever is usually a mild illness, but it is highly infectious. Symptoms of scarlet fever are a 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.”
Secondly, we’re currently seeing a steep rise in cases.
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Why is there so much strep A around this year?
“We have seen a huge rise in cases since September,” says Dr Perry. “According to Dr Susan Hopkins (the chief medical advisor for the UK Health Security Agency) it is thought that this is due to greater social mixing than pre-pandemic, and the fact that children were less exposed to the bacterial infection during lockdown.”
This has led to a sharp uptick in cases, particularly among primary school children and several deaths have sparked concern among parents and the general public. It is important to remember, however, that for the majority of people, a strep A infection will be a mild illness.
“Outbreaks of group A strep do happen every few years,” Dr Zoe Watson, GP locum and founder of Wellgood Wellbeing, reassures us. “The current surge in cases actually still isn’t as high as the last outbreak in 2018, but the current levels are certainly higher than usual for this time of year, so experts are worried this may continue to rise. Currently, there is no evidence that a new strain group A strep is circulating. The increase is most likely related to high amounts of circulating bacteria and increased social mixing after relaxation of social distancing rules.”
How do you catch strep A?
“Strep A is spread through contact with droplets from an infected person when they talk, cough or sneeze,” explains Reid. “Some people can have the bacteria present in their body without feeling unwell or showing any symptoms of infections, and while they can pass it on, the risk of spread is much greater when a person is unwell. It is still possible to infect others for up to three weeks.”
As with any other infectious illness, it’s especially important to be thorough with handwashing, using a tissue to catch coughs and sneezes and staying away from others if you’re unwell – steps we’re all used to, after the last couple of years.
What are the symptoms of strep A?
You may not even know you have a strep A infection, but if you do become unwell, the chances are you’ll suffer from cold-like symptoms. “For some people, strep A may show no symptoms, but others can be very unwell with symptoms such as a high temperature, sore throat, swollen tonsils, temperature, skin rash and earache,” explains Dr Perry.
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How can I tell if I have Covid, strep A or a cold?
As the symptoms of all three are closely linked and extremely common in winter, it can be tricky to tell the difference. Children get three times as many colds per year than adults, so Reid advises: “It’s important to remember that most will have a common seasonal virus, which can be treated by keeping hydrated, and with paracetamol.”
Is it a cold?
“At this time of year, viral infections are very common and prevalent,” reassures Dr Perry. “A simple cold is a viral infection of the nose and throat and normally short-lived and harmless. You can expect a cold to last seven to 10 days, sometimes a little longer depending on lifestyle. The main symptoms of a cold will be runny nose, sore throat, congestion, raised temperature, fatigue, muscle aches and a mild cough.”
What about Covid?
“It is more common to have other symptoms present if it is Covid,” explains Dr Perry. “You’re more likely to have a cough, loss of smell and fever, fatigue and muscle aches, so if you feel it is more than just a cold, it’s best to take a Covid test to be sure.”
Or strep A?
Strep A generally presents as a prolonged sore throat with an accompanying rash, which feels like sandpaper, or strawberry tongue where white lumps appear. Look out for any problems breathing and swallowing and worsening symptoms which last longer than a couple of days and show no sign of improvement.
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When should we worry about strep A?
Since many people will have either no symptoms with strep A infections or feel cold or flu-like, the experts agree it is important to keep an eye on any worsening or persistent symptoms. “In rare cases, the group A bacteria can pass into the bloodstream, causing an illness known as invasive group A strep (iGAS),” explains Dr Perry. “Invasive disease happens when the bacteria get past your body’s immune defences. This can happen when you are already ill or are on treatments, such as some cancer therapies that affect your immune system.”
While still uncommon, there has been an increase in invasive group A strep cases this year, particularly in children under 10, as seen in the news headlines. According to Dr Perry, warning signs of invasive disease include a fever of above 38°C and severe muscle aches.
“You should monitor a rising temperature, particularly in children if they go over 39°C and for babies over 38°C,” advises Dr Perry. “Check for an accompanying rash which feels like sandpaper, or strawberry tongue where white lumps appear, any problems breathing and swallowing and worsening symptoms which prolong after two days and show no sign of improvement. Seek medical advice immediately from your GP and NHS 111 out of hours if you’re concerned.”
How is it treated?
“In general, a group A strep infection starts off as minor, or ‘non-invasive’ but can become more serious, or ‘invasive’ when the bacterium is able to infect areas where it is not usually found, such as the blood and the lungs,” explains Dr Watson. “This can happen if it’s not treated with antibiotics in a timely manner or if the infection simply becomes too overwhelming for the body to cope with, even with antibiotics on board.”
The good news is that when caught early enough, strep A responds well to antibiotic treatment. “Treatment with antibiotics will help you get better quicker, reduce the chance of serious illnesses, such as pneumonia,” advises Reid. “It also makes it less likely that you’ll pass the infection on to someone else.”
The advice is clear: trust your judgment when it comes to a poorly child. If you’re concerned, seek prompt medical attention and remember that, thankfully, strep A outbreaks do tend to be short-lived.
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