HSE contacts schools with advice for parents as child dies from invasive Strep A

LAST UPDATE | 7 Dec 2022

A CHILD IN Ireland has died from invasive Group A Strep (iGAS), with the HSE contacting schools today with advice for parents about the bacterial infection.

Director of the Health Protection Surveillance Centre Dr Éamonn O’Moore said that “the news of a child death with Strep A will be worrying for parents, but it’s important to know that most children who get ill from a Group A Strep infections will have a mild illness which can be treated with antibiotics”.

“Group A Streptococci are a common bacteria that are often and usually relatively mild and self-limiting. They can cause infections like tonsillitis and pharyngitis and scarlet fever,” Dr O’Moore said in a statement.

“The HPSC is closely monitoring Strep A and Scarlet Fever and as yet there is no evidence that a new strain is in circulation. There is likely a combination of factors as to why there has been a slight increase in infection this season, including increased social mixing following the pandemic compared to previous years as well as increases in other respiratory viruses.

“If anyone is unwell with winter virus type symptoms, stay at home to stop the spread, and this includes not sending sick children to crèche or school until they are better.”

Earlier today, Chief Medical Officer Professor Breda Smyth discussed the child’s tragic death, saying “this is a very sad event, so I would like to extend my deepest sympathy to the family of the bereaved”.

The CMO told Virgin Media News: “As you know, I don’t comment on individual cases, but with regard to Group A Strep, I think … there will be a lot of anxiety, so it’s important for parents to know that the majority of cases of Group A Strep are mild infections and can be treated with antibiotics.” 

To date this year, the Health Protection Surveillance Centre (HPSC) has been notified of 55 iGAS cases in Ireland, 14 of which were children aged under 10 years. This compares to 22 cases in children aged under 10 for the said period in 2019. 

21 of the 55 iGAS cases notified in Ireland this year have been reported since the beginning of October, four of which were children. 

GAS infections cause various symptoms such as sore throat, fever, chills and muscle aches.

The HPSC says that if a parent feels that their child is seriously unwell, they should trust their own judgement.

It contacted schools today with information for parents, recommending parents to contact their GP if:

• your child is getting worse
• your child is feeding or eating much less than normal
• your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
• your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
• your baby feels hotter than usual when you touch their back or chest, or feels sweaty
• your child is very tired or irritable.

Parents should call 999 or go to an Emergency Department if:

• your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• there are pauses when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake.

Professor Smyth told RTÉ’s Morning Ireland that during the pandemic, the circulation of Strep A was reduced and there wasn’t as many cases of the bug. Looking at pre-pandemic years, there was 108 cases recorded in 2019 and 136 cases recorded in 2018. 

“So, the number of cases we’ve had this year is actually much lower than pre-pandemic times. But we are keeping a very close eye on it,” she said. 

Professor Smyth indicated that the number of bugs that are currently circulating in children in Ireland is due to reduced social mixing during the Covid-19 pandemic.

She suggested that reduced social contact among children while Covid-19 restrictions were in place during the two most recent winters has led to higher levels of illnesses such as Strep A and RSV. 

“As we know, there are a lot of bugs circulating at the moment because we had a reduced social mixing, particularly in children,” she said.

“During the pandemic, the circulation of the bug [Strep A] had been reduced and we didn’t have very many, many cases,” she added.

What is Strep A?

Group A streptococcus (GAS) is a common bacteria.

Many people carry it in their throats and on their skin and it doesn’t always result in illness.

However, GAS does cause a number of infections, some mild and some more serious.

The most serious infection caused by GAS occurs when it becomes invasive (invasive Group A Strep). That is when the bacteria gets into parts of the body where it is not normally found, such as the lungs or bloodstream. This is called invasive Group A Strep (iGAS) and in rare cases it can be fatal.

Whilst iGAS infections are still uncommon, there has been a small increase in cases this year reported in the UK, particularly in children under 10 and sadly, a small number of deaths, the HPSC has said. 

GAS causes infections in the skin, soft tissue and respiratory tract.

It’s responsible for infections such as tonsillitis, pharyngitis, scarlet fever, impetigo and cellulitis among others.

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

How are Strep A bacteria spread?

GAS is spread by close contact with an infected person and can be passed on through coughs and sneezes or from a wound.

Some people can have the bacteria present in their body without feeling unwell or showing any symptoms of infections and while they can pass it on, the risk of spread is much greater when a person is unwell.

What is invasive Group A Streptococcal disease?

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

This can happen when a person has sores or open wounds that allow the bacteria to get into the tissue, damage in their respiratory tract after a viral illness, or in a person who has a health condition that reduces their immunity to infection.

When the immune system is compromised, a person is more vulnerable to invasive disease.

Necrotising fasciitis, necrotising pneumonia and Streptococcal Toxic Shock Syndrome are some of the most severe but rare forms of invasive group A strep.

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

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. 

What precautions should parents take with their children?

Professor Smyth said today: “If a child has a throat infection that isn’t getting better, or they have a skin infection, and they have a persistent fever … and the fever doesn’t respond to the normal elements like taking paracetamol, and a parent is particularly worried and they think their child is quite sick, it’s important to communicate with their GP or health professional.”

She said that signs a child is not getting better are ”a persistent fever that is not responding to paracetamol, if they are off their food, particuarly if they’re not drinking and if they’re not producing urine, and they’re particularly lethargic”. 

“I would always say to parents to trust your instinct. If you feel your child isn’t getting better with the routine responses, then it’s important to contact your GP or your health professional,” she said. 

Includes reporting by Press Association