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What began when a common bacterial infection killed fifteen children infected with Strep A in the UK.
Health officials have issued a strong warning to parents in the UK as the number of child deaths from the infection continues to rise. The latest victim, a five-year-old girl from Ireland, became seriously ill last week before dying of complications related to Strep A on Monday.
Although pediatric patients usually have mild symptoms such as fever, swollen tonsils, and lymph nodes, complications can occur if the infection enters the bloodstream, resulting in a potentially fatal disease known as invasive group A streptococcus (iGAS).
In the US, iGAS cases fell during the pandemic, but the CDC said so The Independent on Wednesday that doctors in the US have alerted the agency to a possible recent spike, which is now being actively monitored.
What is Strep A and what are the symptoms?
dr Mark Hicar, a pediatric infectious disease expert and associate professor in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, said The Independent that it is difficult to say whether the US could see an outbreak similar to the recent UK one.
Before the 2019 pandemic, seven children under the age of 17 out of every 100,000 in monitored areas died from Strep A complications, according to CDC data.
One death per 100,000 residents in monitored areas was reported in 2020 when the last report was released.
The CDC only tracks iGAs infections and not non-invasive Strep A infections. Only 10 states reported data for iGAS in the latest report.
“Mitigation measures (e.g. school and workplace closures, masking) taken during the first two years of the COVID-19 pandemic helped contain the spread of many viruses and bacteria,” a spokesman said.
“Now that these germs are spreading again, we may revert to typical infection patterns for iGAS, including a seasonal increase in the winter months.
What are Strep A infections?
Group A streptococci are a common bacterial infection that occurs mainly in children.
In the most severe and rare cases, the infection causes diseases such as pink rash (scarlet fever), bacterial infection of the skin (impetigo), necrotizing tissue (fasciitis), streptococcal toxic shock syndrome, pneumonia, and sepsis.
However, the majority of group A streptococcal infections present with mild flu-like symptoms.
“There are many group A streptococci and in the past (2015 and 2018) there have been isolated outbreaks in the UK,” said Dr. Hicar. “…so with the previous surge in UK cases there seemed to be no impact on US cases [whether there will be one now] it’s hard to say.”
dr Hicar says certain strains of infection can lead to a “sandpaper rash,” which commonly causes children to get sicker and is known as “scarlet fever.”
“Usually this happens with [throat infections or] Pharyngitis cases, but can [happen with] also the impetigo infections. This appears to be the form currently reported in the UK,” he said.
He added that immunocompromised children are at greater risk if they contract Strep A.
“Certain children without good spleen function or with other forms of immune depression are at higher risk for sepsis, toxic shock, and necrotizing fasciitis (the ‘flesh-eating’ group A strep infection),” said Dr. Hicar.
The mother of two-year-old Tayden, who was diagnosed with aplastic anemia earlier this year, has been warned by doctors that her daughter could postpone her transplant after the toddler contracted Strep A last week.
“She was restless and tired the day before her fever,” said Heather, who lives in Utah The Independent.
Tayden’s symptoms disappeared within 48 hours after she was given antibiotics. She is expected to be cured for her transplant.
Sore throat is one of the primary signs of Strep A infection
Could post-pandemic infections increase?
A CDC spokesman said The Independent that more data needs to be collected to get a better sense of recent Strep A trends in the US.
“The recent rise in respiratory viruses, particularly influenza, may contribute to a possible increase in iGAS infections. Concurrent or previous viral infections such as influenza and skin conditions such as chickenpox can increase the risk of iGAS infections,” the spokesman said.
dr Hicar added that mask use does not appear to reduce infection.
“Masks help well with respiratory viruses like flu and Covid, but also with other organisms that can linger on surfaces [such as Strep A] tend not to be as affected by mask use,” he said. “[US] Available data from 2020, the first year of the pandemic, appear stable for invasive group A streptococcal infections and mortality rates.”
The CDC estimates 14,000 to 25,000 iGAS cases over the past five years and between 1,500 and 2,300 deaths over the same period.
What symptoms should parents watch out for?
According to the CDC, most children infected with Strep A experience pain when swallowing, fever, red and swollen tonsils (sometimes with white spots or streaks of pus), and swollen lymph nodes in the front of the neck.
dr Hicar tells The Independent that sore throat and fever should go away within a few days. He advised parents to contact their doctor again if symptoms persist.
“If your child has been diagnosed [Strep A] and seemed to get better but then got worse, discuss this with your doctor,” he said. “One of those rare more serious complications could be starting.”
He reiterated that although most cases are safe for children, if the infection reaches the bloodstream (bacteremia), lungs (pneumonia), or brain (meningitis), complications can become fatal.
The new strain of group A streptococci could be more likely to cause serious internal infections
How are children infected?
Overcrowded facilities such as schools and day care centers increase the risk of contracting Strep A.
The bacterium is highly contagious and can be spread through respiratory droplets from speaking, coughing or sneezing and through direct contact if patients develop sores on their skin, according to the CDC.
In very rare cases, it can also spread through food if not passed properly.
“As social animals, we are constantly bombarded by bacteria and viruses, which our immune systems fight off most of the time,” says Dr. Hicar The Independent.
“… the more exposure [a person] has, the more likely they are to become infected. However, there are many benefits of peer interaction and socialization.”
What should you do if you suspect your child has Strep A?
Strep A infections can be diagnosed by a rapid strep test that involves wiping the throat.
Doctors also give patients throat cultures. Although this method takes a day or two, it is more effective than a rapid test.
What is the treatment for Strep A?
There is currently no vaccine to prevent Strep A infection.
Antibiotics relieve symptoms and prevent complications and are the most commonly used form of treatment. After being prescribed antibiotics, patients should feel better within 48 hours.
