Strep A: Fifteen children have died in the UK in recent weeks. Could there be an epidemic in the US?

WIt started as a common bacterial infection that ended in the deaths of fifteen children infected with Streptococcus A in Britain.

The health authorities issued a dire warning parents in the UK as the number of child deaths caused by the infection continues to rise. The latest victim, a five-year-old girl from Ireland, became seriously ill last week before dying on Monday from complications related to Strep A.

Although pediatric patients usually have mild symptoms such as fever, swollen tonsils and lymph nodes, complications can arise when the infection enters the bloodstream, leading to a potentially fatal disease known as invasive group A strep (iGAS).

In the US, cases of iGAS have decreased during the pandemic, but the CDC said The Independent on Wednesday that doctors in the US notified the agency of a possible recent increase, which is now being actively monitored.

dr. Mark Hicar, a pediatric infectious disease specialist and associate professor at the Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, told The Independent that it is difficult to say whether the USA could experience a similar epidemic to the recent one in the UK.

According to the CDC, seven children under 17 per 100,000 in surveillance areas died from complications of strep A before the 2019 pandemic.

One death per 100,000 inhabitants in the observed areas was recorded in 2020, when the last report was published.

The CDC only monitors iGAs infections and does not monitor non-invasive Strep A infections. Only 10 states reported data for iGAS in the latest report.

“Mitigation measures (eg school and workplace closures, masking) used during the first two years of the COVID-19 pandemic helped reduce the spread of many viruses and bacteria,” the spokesperson said.

“Now that these germs are spreading again, we may be returning to typical infection patterns for iGAS, including a seasonal increase in the winter months.

What are strep A infections?

Group A streptococcus is a common bacterial infection, mostly seen in children.

In the most serious and rare cases, the infection causes diseases such as pink-red rashes (scarlet infection), bacterial skin infection (impetigo), necrotizing tissue (fasciitis), streptococcal toxic shock syndrome, pneumonia and sepsis.

However, most group A strep infections have mild flu-like symptoms.

“There are many strains of group A strep and there have been isolated outbreaks in the UK in the past (2015 and 2018),” Dr Hicar said. “… with the previous increase in UK cases, there appears to have been no effect on US cases, so [whether there will be one now] it’s hard to say.”

dr. Hicar says certain strains of the infection can lead to a “sandpaper rash,” which generally makes children sicker and is known as “scab.”

“It usually happens with [throat infections or] cases of pharyngitis, but they can [happen with] also impetigo infections. This appears to be the form currently being reported in the UK, he said.

He added that immunocompromised children are at greater risk when they become infected with Streptococcus A.

“Certain children without good splenic function or who have other forms of immune depression are at greater risk of sepsis, toxic shock and necrotizing fasciitis (flesh-eating group A streptococcal infection),” said Dr. Hicar.

The mother of two-year-old Tayden, who was diagnosed with aplastic anemia earlier this year, was warned by doctors that her daughter could delay her transplant after the toddler contracted Strep A last week.

“She was cranky and tired the day before the fever,” said Heather, who lives in Utah. The Independent.

Tayden’s symptoms disappeared within 48 hours of being given antibiotics. He is expected to recover for a transplant.

Could infections increase after a pandemic?

A CDC spokesperson said The Independent that more data needs to be collected to gain better insight into recent strep A trends in the US.

“The recent increase in respiratory viruses, especially influenza, could contribute to a possible increase in iGAS infections. Concurrent or previous viral infections such as influenza and skin conditions such as chicken pox can increase the risk of iGAS infections, the spokesman said.

Dr. Hicar added that the use of masks does not seem to reduce infections.

“Masks help well with respiratory viruses, such as flu and covid, but also other organisms that can remain on surfaces [such as Strep A] they tend not to be affected as much by the use of masks,” he said. “[US] data available from 2020, the first year of the pandemic, appear stable for invasive group A strep infections and mortality rates.”

The CDC estimates 14,000 to 25,000 cases of iGAS in the past five years, and between 1,500 and 2,300 deaths over the same time period.

What symptoms should parents watch out for?

According to the CDC, most children infected with strep A will 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 talks The Independent that the sore throat and fever should disappear in a few days. He advised parents to see their doctors again if symptoms persist.

“If your child has been diagnosed [Strep A] and seemed to be getting better but then gets worse, talk to your doctor,” he said. “Maybe one of these rare more serious complications is starting.”

He reiterated that although most cases are not dangerous for children, complications can become fatal if the infection reaches the bloodstream (bacteremia), lungs (pneumonia) or brain (meningitis).

How do children get infected?

Crowded environments such as schools and daycares increase the risk of strep A infection.

The bacteria is highly contagious and can be spread by respiratory droplets from talking, coughing or sneezing, and by direct contact when patients develop skin sores, according to the CDC.

In very rare cases, it can also be spread by food that is not given properly.

“As social animals, we are constantly bombarded with bacteria and viruses that most of the time our immune system defends against,” says Dr. Hicar. The Independent.

“… as much exposure as possible [a person] has, they are more likely to be infected. However, the benefits of peer interaction and socialization are many.”

What should you do if you suspect your child has strep A?

Strep A infections can be diagnosed with a rapid strep test that involves a throat swab.

Doctors also give throat cultures to patients. Although this method takes one to two days, it is more effective than a rapid test.

What is the treatment for strep A?

There is currently no vaccine to prevent streptococcal A infections.

Antibiotics reduce symptoms and prevent complications and are the most commonly used form of treatment. After antibiotics are prescribed, patients should feel better within 48 hours.