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Invasive Strep A Has Caused 30 Child Deaths in the UK This Season

Invasive group A streptococcus (iGAS) infections have led to the deaths of 30 children in the UK, latest figures  showed.

The most recent update from the UK Health Security Agency (UKHSA) continued to show an out of season increase in group A strep infections and scarlet fever and a higher number of cases than in a typical year.

So far this season a total of 122 deaths from any cause have been recorded in England within 7 days of an iGAS infection, with 49 (40%) being in those aged 75 years and over, and 20 (16%) in children aged 10 years and under.

The Agency said that 25 children under 18 years had died as a result of an iGAS infection in England between 19 September and Christmas Day.

Public Health Scotland confirmed earlier this week the deaths of two children under 10 years of age in the current season. There have been a further two deaths among children in Wales, and one in Northern Ireland.

iGAS Infections and Deaths

Thursday's update from the UKHSA reported 151 cases of iGAS in England this season in children aged 1 to 4 years compared with 194 cases in that age group for the whole year of the last comparably high season in 2017 to 2018. There had been 25 cases in infants aged 1 year and under, 102 among 5- to 9-year-olds, and 26 in those aged 10 to 14 years.

The relatively high rates of iGAS among children might reflect increases in respiratory viruses and high levels of group A streptococcus (GAS) circulating in children, the UKHSA said. Social distancing measures during the COVID-19 pandemic and a subsequent increase in scarlet fever activity were likely to be important contributory factors, it explained. During the pandemic there was an unprecedented reduction in the number of scarlet fever and iGAS notifications, and reduced exposure to GAS was likely to have resulted in increased levels of susceptibility to these infections in children. Meanwhile, inquiries continued into whether a reported rise in lower respiratory tract GAS infections, particularly empyema, in children over the past few weeks was also driving higher levels of iGAS.

Scarlet Fever Activity

So far this season, from 19 September to 25 December, there have been 33,836 notifications of scarlet fever in England, with 6254 notifications received so far for the week ending December 25. That compared with a range between 443 and 4672 notifications for the same period in the five previous seasons. The UKHSA said that "increased health seeking behaviour as a result of national alerts is likely to have contributed to the increased reports".

The Agency urged clinicians to continue to be alert to the severe complications associated with GAS and to exercise "a high degree of clinical suspicion" when assessing patients, particularly those with a preceding viral infection or who had been a close contact of anyone with scarlet fever.

Dr Obaghe Edeghere, UKHSA incident director, commented: "We are continuing to see a rise in scarlet fever and ‘strep throat’ and this is understandably concerning for parents. However, I would stress that the condition can be easily treated with antibiotics, and it is very rare that a child will go on to become more seriously ill.

"Over the winter, there are lots of illnesses circulating that can make children unwell and so it is important to avoid contact with other people if you are feeling unwell, wash your hands regularly and thoroughly and catch coughs and sneezes in a tissue. I would also urge all those eligible for free winter vaccines to take advantage of these."