The following Urgent Public Health message has been issued by the UK Health Security Agency (UKSHA).
UKHSA - Urgent public health message to all GP practices, urgent care centres, emergency departments, paediatric and infectious disease/microbiology services regarding an increase in invasive Group A streptococcal infections in children, including lower respiratory tract infections with viral co-infection. UKHSA - Urgent public health message: Invasive Group A Strep
Current invasive Group A streptococcus (iGAS) infection notifications remain unusually high for this time of year, particularly in children. Marked increases in scarlet fever notifications are also being seen. Investigations are underway following reports of an increase in lower respiratory tract GAS infections in children over the past few weeks, which have caused severe illness. A high burden of co-circulating viral infections may be contributing to the increased severity and complications through co-infection. Clinicians should continue to be mindful of potential increases in invasive disease and maintain a high index of suspicion in relevant patients as early recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection can be life-saving. Urgent notification to UKHSA Health Protection Teams of iGAS infection is essential to facilitate immediate public health actions including assessment of contacts.
Recommendations for Primary and Secondary Care:
- Given the unusually high level of GAS, and viral co-circulation in the community, health care professionals are asked to have a low threshold to consider and empirically prescribe antibiotics to children presenting with features of GAS infection, including where secondary to viral respiratory illness.
- Consider taking a throat swab to assist with differential diagnosis or if the patient is thought to be part of an outbreak (to confirm aetiology), allergic to penicillin (to determine antimicrobial susceptibility) or in regular contact with vulnerable individuals
- Parents of children with presumed respiratory viral infection should be made aware of features suggestive of secondary bacterial infection, such as clinical deterioration, and when and how to seek further help. Safety netting advice for parents can be found on the link below.
- GPs should maintain a low threshold for prompt referral to secondary care of any children presenting with persistent or worsening symptoms.
Recommendations for Secondary Care:
- Maintain a low threshold for considering pulmonary complications of GAS, especially if presenting with: an illness compatible with bacterial pneumonia, scarlet fever, GAS infection, or if GAS was recently isolated, or the patient was recently in contact with a case of scarlet fever/GAS infection. Prompt initiation of appropriate antibiotics remains key.
- In the case of culture-negative fluid specimens, please use molecular diagnostics such as GAS-specific PCR or 16S rDNA PCR, as guided by microbiology specialists.
- Clinicians are further reminded of the importance of rapid notification of all cases of severe GAS infection (including pneumonic complications/ empyema) to Health Protection Teams to facilitate rapid assessment of contacts and identification of epidemiological links with other cases, as per national public health guidelines linked below. Severe GAS cases encompass cases of invasive disease (iGAS) defined through the isolation of GAS from a normally sterile site, plus additional cases where GAS is isolated from a non-sterile site in combination with clinical signs consistent with a severe infection (streptococcal toxic shock syndrome, pneumonia, necrotising fasciitis, puerperal sepsis, meningitis, septic arthritis). This includes cases diagnosed via culture or molecular methods.
Health Protection Report: https://www.gov.uk/government/publications/group-a-streptococcal-infections-activity-during-the-2022-to-2023-season
Safety netting documents: https://what0-18.nhs.uk/professionals/gp-primary-care-staff/safety-netting-documents-parents
Notification of infectious diseases: https://www.gov.uk/government/collections/notifications-of-infectious-diseases-noids