Alert after Strep A kills six children
Cases now five times higher than before pandemic as fears of school contagion grow
SIX children have died from a Strep A infection in the past month, as officials warned that lockdown had left youngsters vulnerable to dangerous diseases.
Health chiefs last night issued an alert to parents after cases of severe Strep A and scarlet fever were shown to be nearly five-times higher among children than before the Covid pandemic.
Parents have been told to look out for symptoms such as their child having a worsening sore throat and a prickly red rash and to “see a doctor as quickly as possible” amid concern that the bacterial condition is circulating in schools.
The UK Health Security Agency (UKHSA) said it was also investigating an increase in chest infections caused by Strep A over the past few weeks “which have caused severe illness”.
The six children who died had invasive Group A Strep (IGAS). These included youngsters from Ealing, Surrey and High Wycombe, as well as Wales.
The parents of Hanna Roap, a sevenyear-old girl from Penarth in Wales who died on Nov 25, said “our heart is broken into a million pieces”.
Scientists said the decision to close schools and keep children apart during lockdown had left a wider pool of youngsters without immunity to the bacteria.
One Whitehall source said: “There may be a few more cases now than there would have been before Covid because all these kids didn’t get any infection during the pandemic and therefore there are more kids around who haven’t had it.”
The surge comes as the NHS faces crippling winter pressures with record waiting lists and patients struggling to get a face-to-face GP appointment. Health officials fear the surge may lead to further child deaths in the coming weeks.
Strep A is a very common bacterial infection which causes tonsillitis, also known as Strep throat, and can also lead to impetigo or scarlet fever. All Strep A infections can be treated with antibiotics, usually penicillin. But in rare and the most severe cases the bacteria enters the bloodstream and leads to IGAS, which can trigger lethal sepsis, shock or meningitis. UKSA figures show that cases of IGAS in England have increased from 0.5 per 100,000 children aged one to four years old before the pandemic to 2.3 per 100,000 in recent weeks. The figure for five- to nine-year-olds has also increased from 0.3 per 100,000 to 1.1.
Cases of scarlet fever rose to 851 last week, a huge rise compared with the average of 186 cases before Covid. A case in Surrey led to a localised outbreak among a handful of schools with one now closing communal water fountains.
Authorities have given out powerful preventative antibiotics to the teachers and other pupils at schools where a child has caught the infection, it is understood.
Last night Hanna Roap’s parents said their daughter may have survived if a GP had prescribed her antibiotics, instead of steroids. “She did not get the right medication, if she had been given antibiotics it could have been potentially a different story,” said her father, Abul Roap, 37.
GPS have been instructed to limit their prescriptions of antibiotics as part of an NHS initiative to try and combat the rise in superbugs. The BMA also resisted moves earlier this year to allow pharmacists to sell antibiotics over the counter, saying the medication is “a precious resource” and should only be given out “when absolutely necessary”.
The UKHSA has encouraged parents to wash their children’s hands properly with soap for 20 seconds, have them use a tissue to catch coughs and sneezes and to keep them away from others when feeling ill.
Parents were urged to contact 111 or a GP if their child’s appetite has changed dramatically, or if they have a fever or a dry nappy for over 12 hours. They should call 999 or go to A&E if their child is having difficulty breathing, their skin or lips turn blue, or if they are floppy or cannot stay awake.
Dr Colin Brown, of the UKHSA, said Strep A cases are higher than usual and that it is normally a mild infection which is easily treated with antibiotics. He also encouraged parents to be on the lookout for signs of Strep A – a sore throat which worsens over time, headache, fever and a red rash which is rough to the touch, and to see a doctor “as soon as possible” to stop the infection getting worse.
THE father of a child who died after catching Strep A has said she may still be alive if she had been given antibiotics.
Hanna Roap, a seven-year-old girl from Wales, is one of six children to die in the last few weeks of a severe form of Strep A infection called invasive Group A Strep (IGAS).
Cases of the disease in primary school aged children are up four-fold compared to pre-pandemic levels and parents are being urged to keep an eye on their child in case they show symptoms of a Strep A infection.
Hanna was prescribed steroids after waking up coughing on the evening of Nov 25, but died less than 12 hours later.
Her father, Abul Roap, 37, said: “I took her home from the doctors and gave her the medication.
“She went to sleep at 4pm and never woke up. She stopped breathing at 8pm but we were not immediately aware because she was sleeping.
“I did CPR. I tried to revive her but it didn’t work. Paramedics arrived and continued the CPR but it was too late.
“She did not get the right medication, if she had been given antibiotics it could have been potentially a different story.”
Muhammad Ibrahim Ali, a four-yearold boy from High Wycombe, was given antibiotics for Strep A but died at his home later that day after suffering a cardiac arrest.
His family told the local press that Muhammed was rushed to the doctors after developing a rash and given antibiotics but died that evening. His family were told Muhammed had IGAS in his bloodstream for a month.
Data show IGAS rates have soared to a level more than four-times higher than they were before the Covid pandemic, with more child deaths already this winter than in a normal year.
Strep A infection is common and mostly leads to tonsillitis or strep throat and is easily treatable with antibiotics, namely penicillin in the UK.
But doctors are under increasing pressure to cut down on the amount of antibiotics they prescribe as a result of the rise of superbugs – bacteria which are resistant to antibiotics.
Superbugs are predicted to kill 10 million people a year by 2050, with experts saying this “silent pandemic” is humanity’s gravest threat.
The UK health authorities have previously trialled paying healthcare providers to cut down on their antibiotic prescription levels and set a target of slashing prescription by 15 per cent.
The British Medical Association (BMA) pushed back against plans to let pharmacists prescribe antibiotics as “antibiotics are a precious resource and should be prescribed only when absolutely necessary”.
But while antibiotics are overprescribed by around 40 per cent, and often given for colds caused by viruses which are impervious to the drugs, there are no tests available to GPS to tell if a sick child has a bacterial or viral infection.
As a result, doctors are tasked with cutting down on giving out antibiotics without really knowing which patients need them and which ones do not.
Lord Jim O’neill, the economist behind the seminal 2016 review of antimicrobial resistance which was commissioned by then prime minister David Cameron, said: “The price of an antibiotic currently is always cheaper than the price of a diagnostic.
“It seems to me slightly mad, as brilliant as doctors are, that they guess whether somebody wants an antibiotic in the first place, and then what kind of antibiotic,” Lord O’neill added.
But now, while progress has been made in reducing antibiotic prescrip
‘I tried to revive her but it didn’t work. Paramedics continued but it was too late. She did not get the right medication’
‘She went to sleep and never woke up. She stopped breathing but we were not immediately aware as she was sleeping’
tions, a bacterial infection which is easily treatable has killed six children who may have survived if given antibiotics earlier.
Strep A is a bacteria sometimes found in the throat or on the skin and caught through close contact and from coughing and sneezing and normally leads to Strep throat.
In severe cases it can lead to invasive Group A Strep if it gets into the bloodstream via cracks in the skin or if a child has a weakened immune system. IGAS can lead to sepsis or shock and, in extremely rare cases, meningitis and it can rapidly kill a patient.
Data from the UK Health Security Agency (UKHSA) show that in pre-pandemic times for children aged between one and four years old there were 0.5 cases of IGAS per 100,000. The current figure is 2.3 per 100,000.
For children aged between five and nine years old it has more than tripled, up from 0.3 per 100,000 to 1.1 per 100,000. Cases of scarlet fever, which is a different disease but caused by the same bacteria, have also increased in recent months. Official data show that in the most recent week there were 851 cases of scarlet fever, more than four and a half times the average number of cases (186) as in the same week in prepandemic times of 2017-19.
So far this season there have been six recorded deaths within seven days of an IGAS diagnosis in children under 10 in England. During the last high season for Group A Strep infection in 2017/18 there were four deaths in children under 10 in the equivalent period.
An outbreak at a school in Surrey has also seen powerful antibiotics given out widely to get it under control. Neighbouring schools have also recorded cases of Strep A, with one saying it has turned off shared water fountains to reduce the risk of transmission.
Scientists in Australia this week discovered a superbug strain of Strep A that is undetectable by current lab methods and is immune to some antibiotics, but health officials do not believe the current strain in the UK to be a superbug variant of Strep A.
The UKHSA said the surge in cases is due to high amounts of the bacteria circulating in the population and high levels of mixing.
But experts have said the rise in cases is likely tied to the suppressed circulation of seasonal diseases over the last two winters – following Covid-19 restrictions – leading to a bigger pool of exposed children than normal.
A senior health expert in the Government said: “Now that everything’s going back to normal we are going to see these cases coming back just like we did before the pandemic.
“There may be a few more cases now than there would have been before [Covid] because all these kids didn’t get any infection during the pandemic and therefore there are more kids around who haven’t had it,” the senior health expert added.
“If this had been spread over three years it may not be as high at all but because they’re all getting it together it looks like there’s a lot more infections.”
Earlier this year, a hepatitis outbreak in children was also linked to cases of the common cold surging after a loss of immunity following two years of lockdowns.
There is limited data on the global burden of all Strep A-related diseases, but it is postulated to be the fifth most lethal pathogen in the world.
A review of the burden of Strep A diseases published in The Lancet this summer estimated there are 288.6 million episodes of Strep A throat among children aged 5–14 years globally.
The World Health Organisation has highlighted the potential value of Strep A vaccines in reducing antibiotic resistance.