Strep A

Strep A, also known as Group A Strep, strep, and strep throat, is a common bacteria called group a streptococcus (GAS). Lots of us carry it in our throats and on our skin and it doesn’t always result in illness. However, Strep A does cause a number of infections, some mild and some more serious.

Milder infections caused by Strep A include scarlet fever, impetigo, cellulitis, tonsillitis and pharyngitis (a sore throat). These can be easily treated with antibiotics.

The most serious infections linked to Strep A come from invasive Group A Strep, known as iGAS, a rare infection caused by the bacteria getting into parts of the body where it is not normally found like the lungs or bloodstream.

Jump to our FAQs for advice on what to do if you are worried.

More information on Strep A and iGAS is available on the NHS website.

Scarlet Fever

The UK is currently seeing high numbers of scarlet fever cases, which is an illness linked to Strep A.

The first signs of scarlet fever are flu-like symptoms, including:

  • a high temperature (of at least 38C, or 100.4F – thermometers are available at local pharmacies)
  • a sore throat / tonsillitis
  • swollen neck glands (glands are large lumps on the sides of your neck)
  • a white coating on the tongue, which is red and then peels and leaves a ‘strawberry’ tongue;
A child showing their tongue, with a white coating on it - which might be one of the symptoms for scarlet fever
Image courtesy of “Don’t forget the bubbles” – dontforgetthebubbles.com
  • 12 to 48 hours later, a rash appears. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes the skin feel rough, like sandpaper. The rash is worse in the skin folds e.g. groin. On white skin the rash looks pink or red. On brown and black skin it might be harder to see a change in colour, but you can still feel the rash and see the raised bumps.
Arm of a child with small bumps on it - which might be one of the symptoms for scarlet fever
Image courtesy of “Don’t forget the bubbles” – dontforgetthebubbles.com
Chest of a child with a rash that looks like small, raised bumps and can be one of the symptoms of scarlet fever
Image courtesy of “Don’t forget the bubbles” – dontforgetthebubbles.com

While infections like scarlet fever can be unpleasant, they rarely become serious. When treated with antibiotics, an unwell person with a mild illness like scarlet fever stops being contagious around 24 hours after starting their medication.

Most scarlet fever symptoms resolve in a week. After the symptoms have resolved, it is common to get peeling skin on the fingertips.

If your child has a runny nose, cough or diarrhoea, they are unlikely to have scarlet fever and are more likely to have a viral infection which will resolve itself.

Occasionally, the bacteria causing scarlet fever can spread to other areas of the body, causing infections in the neck (tonsillar or lymph node abscesses), chest infections (pneumonia) or sepsis.

More information on scarlet fever can be found on the NHS website, including photos. Further information about scarlet fever can also be found on the Public Health England website.

iGAS

The most serious infections linked to Strep A come from invasive Group A Strep, also known as iGAS.

This can happen when a person has sores or open wounds that allow the bacteria to get into the tissue, breaches in their respiratory tract after a viral illness, or in a person who has a health condition that decreases their immunity to infection. When the immune system is compromised, a person is more vulnerable to serious, invasive disease.

iGAS infections are rare, and a person with iGAS needs urgent medical attention.

FAQs

What should I do if I am worried my child has Strep A, scarlet fever, or iGAS?

As explained above, milder infections caused by Strep A include scarlet fever, impetigo, cellulitis, tonsillitis and pharyngitis (a sore throat). Check your child’s symptoms and follow the advice here and in our FAQs below.

While case numbers are high, parents should be on the lookout for scarlet fever symptoms of scarlet fever so that appropriate and timely treatment can be given by your GP. It is usually a mild illness that clears up quickly after a course of antibiotics.

To make your child more comfortable if they have scarlet fever, you may want to lower their temperature using paracetamol (calpol) and/or ibuprofen. Use one and if your child has not improved 2/3 hours later you may want to try giving the other medicine. However, remember that fever is a normal response that may help the body to fight infection and paracetamol/ibuprofen will not get rid of it entirely.

Avoid tepid sponging your child – it doesn’t actually reduce your child’s temperature and may cause your child to shiver.

Encourage them to drink plenty of fluids.

Despite the out of season increase we are seeing in scarlet fever and other Strep A infections, the risk of the bacteria causing a more serious infection like iGAS remains very low.

When should I call 999 or go to A&E?

Call 999 or go to A&E If your child has any of the following:

  • Is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
  • Becomes pale, mottled and feels abnormally cold to touch
  • Is going blue around the lips
  • Too breathless to talk / eat or drink
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake) or floppy
  • Develops a rash that does not disappear with pressure (the ‘Glass Test’)
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

When should I contact NHS 111 or my GP?

Contact NHS 111 or your GP if your child is:

  • Unable to swallow saliva or is drooling
  • Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours)
  • Is feeding or eating much less than normal
  • Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) – especially if they remain drowsy or irritable despite their fever coming down
  • Has extreme shivering or complains of muscle pain
  • Develops a painful, red swollen gland in their neck which is increasing in size
  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Continues to have a fever of 38.0°C / 100.4°F or more for more than 5 days
  • If your child has recently had scarlet fever but now appears to have a puffy face/eyelids, tea ‘coca-cola’ coloured urine (pee), or a swollen, painful joint(s)
  • Is getting worse or if you are worried

Contact your GP or use the NHS 111 website.

If none of the above features are present please continue looking after your child at home and ask for help from your pharmacist to keep your child more comfortable.

Who needs to take antibiotics?

Antibiotics are not routinely recommended to prevent anyone becoming unwell and antibiotic treatment should only be taken in confirmed cases of scarlet fever or another Strep A infection, or in certain circumstances where health professionals recommend their wider use.

Any childs with symptoms of an infection linked to Strep A, like scarlet fever, should see their GP and will be prescribed antibiotics if needed.

Children are not infectious with scarlet fever after 24 hours on antibiotic treatment and can return to school once they’re feeling well enough after this period.

Why can’t I get antibiotics if my child has a cold, just in case they also get scarlet fever?

Antibiotics do not work on viral illnesses like common colds.

How long should children diagnosed with scarlet fever be off school for?

Children should not attend school until they have had 24 hours of antibiotics. If they have not been or cannot be prescribed antibiotics they should remain away from school for two weeks.

Are children with chickenpox more vulnerable to iGAS?

Children who have had chickenpox recently are more likely to develop serious forms of Strep A infection, although this remains very uncommon. The chickenpox rash can make it easier for Strep A to get into the body, which can lead to invasive infection. If a child has chickenpox – or has had it in the last two weeks – parents should remain vigilant for symptoms such as a persistent high fever, cellulitis (skin infection) and arthritis (joint pain and swelling).

If you are worried about your child because they have recently had chicken pox and you think they are becoming unwell with any of these symptoms please seek immediate medical advice.

How can we stop infections from spreading?

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap and warm water for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up, or spreading, infections.

What are schools being asked to do?

Schools are being asked to follow the usual outbreak management processes as set out in government guidance if an outbreak of scarlet fever is identified. An ‘outbreak’ is defined as 2 or more probable or confirmed cases attending the same school, nursery or other childcare setting within 10 days of each other.

Schools and nurseries should contact their local Health Protection Team if:

  • You have one or more cases of chickenpox or flu in the class that has scarlet fever at the same time. This is because infection with scarlet fever and either chickenpox or flu at the same time can result in more serious illness.
  • You are experiencing an outbreak of scarlet fever in a setting or class that provides care or education to children who are clinically vulnerable.
  • The outbreak continues for over 2 weeks, despite taking steps to control it.
  • Any child or staff member is admitted to hospital with any Group A Strep (GAS) infection (or there is a death).

Schools where outbreaks occur are additionally advised to:

  • Make sure that all children and employees that are ill go home and don’t return until they are well.
  • Tell parents and visitors about the cases of illness.
  • Remind employees to wash their hands throughout the day. Hand washing needs to be done after changing nappies and helping children use the toilet.
  • Make sure that all cuts, scrapes and wounds are cleaned and covered. This also applies to bites.
  • Carry out regular cleaning throughout the day, especially hand contact surfaces – this is covered in Managing Outbreaks and Incidents. Advice may also be given to increase cleaning of areas with particular attention to hand touch surfaces that can be easily contaminated such as door handles, toilet flushes and taps and communal touch areas. These should ideally be cleaned using a disinfectant.
  • Consider stopping messy play, removing hard to clean soft toys, not going on visits outside of your setting and not allowing children to share drinks.
  • Once cases have stopped (no new cases or illness for 10 days), do a full cleaning of buildings (including toys, carpets etc).

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