Child deaths from Group A Strep

Group A strep bacterium causes scarlet fever, which has caused nine UK child deaths this season. Most likely Respiratory viral infections Group A streptococcus Invasive Group A streptococcus https://what0-18.nhs.uk Currently high rates in the UK https://www.gov.uk/government/news/ukhsa-update-on-scarlet-fever-and-invasive-group-a-strep Higher than normal for the time of year UK, Notifiable diseases https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report#list-of-notifiable-diseases Week 46, (W/E 19th November) 851 reported cases (Average is 186 cases) Close contact, droplets, hands, food Incubation, 2 to 5 days Most common, 2 years to 8 years 90% under 10 years Typically lasts for 7 – 10 days Rash disappearing in 7 to 10 days Should ne immune for decades or life Invasive Group A strep (iGAS) Rare occasions, bacteria get into the bloodstream More cases of iGAS, particularly in children under 10 Scarlet fever Caused by the bacteria Group A streptococcus Usually a mild illness Highly infectious At increased risk Elderly Immunocompromised Clinical features Sore throat/tonsillitis Headache Fever (temperature of 38°C (100.4°F) or above Painful, swollen glands in the neck A red tongue (strawberry tongue) Rash of scarlet fever Starts 12 to 48 hours after symptoms Often begins with small spots on the body, then spread to the neck, arms and legs over the next 1-2 days. Fine, pinkish or red body rash It is often 'sand-paper' like to touch (but not itchy) Darker skin, rash more difficult to see Sandpapery feel Diagnosis of scarlet fever / Group A strep less likely Child who also has a runny nose with their tonsillitis Antibiotics Reduce the chance of infection becoming more severe Stop spread of infection Penicillin V Amoxicillin (Plenty in the UK) 10 days Finish the course Home until at least 24 hours after the starting Possible complications Occasionally, Group A streptococcus can spread to other areas of the body, Tonsillar abscesses Neck lymph node abscesses Chest infections (pneumonia) Bone and joint infections (spetic arthritis) Sepsis Red warning signs Pale, mottled and feels abnormally cold to touch Difficulty breathing, grunting noises, indrawing Cyanosis, skin, tongue, lips Has a fit/seizure Is extremely agitated Non blanching rash Child is floppy and will not wake up or stay awake Amber signs Rapid breathing Unable to swallow saliva Features suggestive of scarlet fever Seems dehydrated, dry nappy Drowsy or irritable Shivering or complains of muscle pain Painful, swollen gland in the neck Baby is under 3 months and has a temperature of 38°C / 100.4 °F Baby feels hotter than usual or feels sweaty Is 3-6 months temperature of 39°C / 102.2°F or above Continues to have a fever of 38°C or above, more than 5 days Child has recently had scarlet fever Puffy face/eyelids (renal involvement) Tea 'coca-cola' coloured urine Swollen, painful joint(s) Is getting worse or if parents are worried In the week or two after recovering from scarlet fever Post streptococcal glomerulonephritis Post-streptococcal arthritis Later Rheumatic heart disease Is this a new strain? High amounts of circulating bacteria Social indoor mixing Is this a post lockdown effect?