Explainer: What is Strep A infection and how are people affected?

THE HSE IS investigating if a four-year-old child has died from Strep A in Ireland. 

Speaking to RTÉ’s News at One today, Dr Eamonn O’Moore, Director for National Health Protection with the HSE and HPSC said that while the cause of death in the child has not yet been officially confirmed, Strep A is being “actively investigated” as a potential cause of death. 

This comes after it was confirmed earlier today that a five-year-old girl in Northern Ireland has died from an illness linked to the bacterial infection Strep A. 

The young girl became ill last week and was receiving treatment at the Royal Belfast Hospital for Sick Children. 

Schools across the UK have also been on high alert due to a rise in Strep A related illnesses. 

Eight other children have died from a form of Strep A in England and Wales. 

So, what exactly is Strep A?

Group A Streptococcus (Group A Strep or Strep A) bacteria can cause many different infections.

The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.

Infections cause by Strep A range from minor illnesses to serious and deadly diseases.

They include the skin infection impetigo, scarlet fever and strep throat.

While the vast majority of infections are relatively mild, sometimes the bacteria cause life-threatening illness called invasive Group A Streptococcal disease.

How are Strep A bacteria spread?

The bacteria are spread by contact with an infected person or by contact with infected skin lesions.

Bacteria can be passed from person to person by close contact such as kissing or skin contact.

The risk of spread is greatest when somebody is ill, such as when people have strep throat or an infected wound.

What is invasive Group A Streptococcal disease?

Invasive Group A Strep disease is sometimes a life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle or lungs.

Two of the most severe, but rare, forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.

Necrotising fasciitis is also known as the “flesh-eating disease” and can occur if a wound gets infected.

Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure/shock and damage to organs such as the kidneys, liver and lungs.

This type of toxic shock has a high death rate.

Dr Eamonn O’Moore said: “When things become serious and dangerous is when the bug becomes invasive … this is where the bug gets into parts of the body where it’s not normally found such as the lungs and the bloodstream, and in those circumstances, things can be very serious indeed.”

Can these illnesses be treated?

Strep A infections such as scarlet fever and impetigo are treated with antibiotics.

After a full 24 hours of antibiotics, people are generally thought to no longer be contagious.

Anyone thought to have invasive Group A Streptococcal disease should seek medical help immediately. Antibiotics, other drugs and intensive medical attention are likely to be needed.

What are the signs of Strep A infections? 

Impetigo is a skin infection which starts with red sores or blisters that then burst, leaving crusty, golden patches. The infection can be treated with antibiotics.

Scarlet fever symptoms are often flu-like, including a high temperature, a sore throat and swollen neck glands.

A rash appears 12 to 48 hours later, starting on the chest and stomach and then spreading.

A white coating also appears on the tongue which peels, leaving the tongue red, swollen and covered in little bumps (often called “strawberry tongue”).

Signs of necrotising fasciitis include fever (a high temperature above 38C), severe pain and swelling, and redness at the wound site.

Early signs and symptoms of toxic shock may include fever, dizziness, confusion, low blood pressure, rash and abdominal pain. 

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Dr O’Moore told News at One that symptoms to look out for were sore throat, fever, chills and muscle aches. 

What precautions should parents take with their children?

Dr O’Moore urged parents to trust their own judgement if they feel their child is getting worse and to contact their GP in those instances. 

A parent should call 999 or go to the Emergency Department if a child is having any difficulties with breathing. 

Speaking to RTÉ’s Today with Claire Byrne, Derry-based GP Dr Nicola Herron also urged parents to be aware of the symptoms of Strep A. 

Dr Herron said that if a child as a high temperature not to send them to creche or school, as even if they don’t have Strep A, any spread of illness can leave other children vulnerable. 

She said GPs have been seeing lot of sore throats and chesty coughs persisting for weeks. She added that while most children are coping, Strep A has a “personality of its own”.

“It comes with a rash that feels like sandpaper it’s really rough, the tongue becomes red with white spots and children generally get more sick than they were three or four days beforehand and can get swollen glands underneath the chin,” Dr Herron said. 

How many cases of Strep A have been recorded in Ireland so far this year? 

Dr O’Moore said there had been 55 confirmed cases of Strep A in Ireland to date this year. 

Two deaths had been associated with the illness, both of which were in older people, he said. 

Of the 55 cases reported, 16 cases occured in children. 

Why are people talking about Strep A this year? 

Dr O’Moore explained that during the Covid-19 pandemic, the HSE saw a reduction in Strep A infections reported to them. So, in short, it just hasn’t been as prevelent in society in the last few years. 

Pre-pandemic, however, a total of 136 cases were recorded in 2018 and 108 cases were recorded in 2019. 

As noted above, there has been 55 confirmed cases of Strep A in Ireland to date, so the infections are on the rise again this year.

With reporting by Press Association