Group A Streptococcus and Scarlet Fever

Group A streptococcus (GAS), also referred to as Strep A, is a common bacterium. Lots of us carry it in our throats and on our skin and it doesn’t usually result in illness. However, GAS can cause a number of infections, some mild and some more serious. 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.

The most serious infections linked to GAS come from invasive group A strep, known as iGAS.

These infections are caused by the bacteria getting into parts of the body where it is not normally found, such as the lungs or bloodstream. In rare cases an iGAS infection can be fatal.

Whilst iGAS infections are still uncommon, there has been an increase in cases this year, particularly in children under 10 and sadly, a small number of deaths.

Scarlet fever, which is caused by Strep A, is usually a mild illness but it is highly infectious. It much more common in children than in adults; it is important that children with scarlet fever are seen by their GP so that they can be started on antibiotics. This is not only to reduce the chance of their infection becoming more severe but also to stop them spreading the infection to others at high risk of severe illness.

The rash of scarlet fever often begins with small spots on the body that then spread to the neck, arms and legs over the next 1-2 days. It is often 'sand-paper' like to touch but is not itchy.

Strep A can also cause children to have:

• Sore throat/tonsillitis
• Fever (temperature of 38°C (100.4°F) or above)
• Painful, swollen glands in the neck
• A red tongue (strawberry tongue)

If your child also has a runny nose with their tonsillitis, it makes a diagnosis of scarlet fever / Group A strep less likely.

If you think your child has scarlet fever, they should be seen by their GP. They may need treatment with antibiotics.

For advice on how to help your child visit: https://www.hwehealthiertogether.nhs.uk/parentscarers/worried-your-child-unwell/scarlet-fever

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.

A negative throat swab is not required for children to attend childcare. Children and adults with suspected scarlet fever should be excluded from nursery / school / work for 24 hours after the antibiotic treatment has started.

Call 999 or go to A&E if your child:

• Becomes pale, mottled and feels abnormally cold to touch
• Is going blue around the lips
• Too breathless to talk / eat or drink
• Has a fit/seizure
• Becomes extremely agitated (crying inconsolably despite distraction), confused of very lethargic (difficult to wake)
• Develops a rash that does not disappear with pressure (the 'Glass Test')
• Is under 1 month of age with a temperature of 38°C/100.4°F or above
• Is finding it hard to breathe

Contact NHS 111 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 38°C, or is older than 3 months and has a temperature of 39°C 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

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.