Britain’s most senior doctors have today issued fresh guidance on the symptoms of Strep A and the steps worried parents should take after warning that current advice isn’t clear enough.
NHS services have been left in ‘meltdown’ from the bug outbreak, with GP surgeries, A&Es and 111 call centres overwhelmed by a wave of parents panicking that their child may be infected.
Professor Kamila Hawthorne, chair of the Royal College of General Practitioners (RCGP), said ‘we want to see good public health messaging across the UK’.
The RCGP, working with two other royal colleges, said it was important to make it ‘clear to parents when they should seek help’ — as well as when ‘they don’t need to’.
Fifteen children in the UK have died so far this winter from the usually-mild infection, which can trigger life-threatening complications in extremely rare cases. Authorities say the toll, although low, is unusually high for this time of year.
Strep A antibiotic shortage sparks calls for pharmacists to get immediate powers to dish out alternative drugs
Pharmacists should have powers to give patients alternative drugs if the one they are prescribed is not available, a top doctor has said.
Professor Kamila Hawthorne, chair of the Royal College of GPs, said the current outbreak of the Strep A bacterial infection among children highlighted the need for the rule change.
The outbreak, which has killed 15 children in the UK, has seen patients and pharmacists struggle to access the antibiotics needed to clear the infection.
Health leaders and ministers insist their is plenty of the drugs nationally but admit there may be short-term supply problems in some areas.
The GP in South Wales was asked by a fellow family doctor on BBC Radio 4’s Today programme why pharmacists aren’t allowed to switch patients prescription from liquid formulations of Strep A antibiotics to tablets, when the former is unavailable.
Professor Hawthorne said regulation means pharmacists can’t dispense something different to what is written on a patient’s prescription.
Asked whether that needs to be looked at quickly, she said: ‘Yes. I think it does need to be looked at.
‘And in fact, I’ve spoken to Susan Hopkins, the medical director of the UKHSA, about this the day before yesterday, and to Chris Whitty (England’s chief medical officer) as well.
‘I think that, not only do pharmacists need to be able to dispense a different formulation of that antibiotic, but if that antibiotic is just not available there are other alternatives that are just as good.’
She added: ‘It is being discussed. Whether or not it will happen, I don’t know. But for the time being, parents should not worry. What would happen is the pharmacists would contact the GP, who would then prescribe the alternative.’
Fresh guidance, published by the RCGP, the Royal College of Paediatrics and Child Health and the Royal College of Emergency Medicine, is aimed at ‘worried parents and healthcare professionals’.
It points to data from the UK Health Security Agency, which shows that Strep A infections are on the rise and are ‘higher than we would typically see at this time of year’. Severe complications from Strep A infections are two-and-a-half times higher among children compared to a previous ‘bad’ season.
Strep A bacteria, carried by a fifth of people at any given time, usually trigger no or mild symptoms and is ‘very treatable’, the guidance says.
The bug can trigger a range of mild of infections, including impetigo, strep throat and scarlet fever.
The colleges urged parents to be on the lookout for early scarlet fever symptoms — including a sore throat, headache, fever, nausea and vomiting.
Within 12 to 48 hours, a red sandpaper-like rash develops on the chest and stomach, before ‘rapidly spreading’ to other parts of the body. Youngsters usually also have red cheeks and a bright red tongue.
In very rare Strep A cases, the bacteria can spread to the bloodstream and trigger an illness called invasive Group A Strep (iGAS).
UKHSA figures show 659 cases of iGAS have been detected in England this season, 60 of which have been fatal.
Nearly 170 of the cases have been among under-14s, 13 of whom have died. Another two children have died in Wales and Northern Ireland.
The colleges said the ‘rising number of infections have understandably caused anxiety among parents’. But it warned that there are lots of winter viruses that cause sore throats, colds and coughs, which ‘generally resolve without medical intervention’.
However, it advised parents to trust their own judgment if their child seems unwell.
The doctors, along with the UKHSA, advised parents to call NHS 111 or their GP if their child is becoming more ill, eating less than usual, shows signs of dehydration or is very tired or irritable.
Parents should call 999 or go to A&E if their child is struggling to breathe, their skin, tongue or lips are blue or they are struggling to stay awake.
It also issued guidance for NHS staff to ‘think Group Strep A’ amid the rise in cases.
Doctors should have a ‘high index of suspicion’ among those with a possible infection because ‘prompt’ treatment can make a ‘significant difference’.
The colleges urged medics to notify the UKHSA of any scarlet fever or iGAS cases so its teams can ‘facilitate immediate public health actions including contact tracing’.
The map shows the rate of iGAS per 100,000 people in England between September 12 and December 4. Rates were highest in Yorkshire (1.8) and the South East (1.4)
The UKHSA has logged 6,601 cases of scarlet fever — which is caused by Strep A — between September 12 and December 4 (green line). For comparison, just 2,538 cases had been reported by this point in 2017/18 (thin blue line), which was considered a ‘bad’ season
Between September 12 and December 4, the UKHSA was notified of 659 iGAS cases (grey line). Rates are currently higher than the previous five winters
What are the symptoms of Strep A? How does it spread? And is it the same as scarlet fever? Everything you need to know about the killer bug sweeping Britain
What 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 caused 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 an illness called invasive Group A Streptococcal disease.
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.
It warned that demand for penicillin and amoxicillin – two antibiotics used to treat Strep A infections – have soared.
Doctors may need to prescribe tablets or capsules instead of liquid forms of the drugs and advise how these should be given to children, the guidance states.
Parents and pharmacists have told of difficulties accessing antibiotics in recent days at local hospitals and chemists.
Ministers and health chiefs insist there is no national shortage of the drugs but admit there may be some areas that temporarily suffer supply problems.
The heads of the three colleges — Dr Camilla Kingdon (RCPCH), Dr Adrian Boyle (RCEM) and Professor Kamila Hawthorne (RCGP) — issued a joint statement to parents.
They said: ‘During any winter period colds, flus and bugs are widespread.
‘But with the recent increase in Strep A cases, it’s no wonder that parents are very worried.
‘We would like to reassure parents and carers that this specific infection is both common and treatable.
‘In fact, the majority of children will recover on their own without the need for antibiotics.’
They added: ‘The UKHSA are monitoring the situation closely and healthcare professionals are now on high alert for any potential cases of Strep A and scarlet fever.
‘As always, if parents are worried about their child’s health, we would urge that they seek medical assistance from a pharmacist, their GP or by calling 111 as a first port of call.’
It comes after Professor Hawthorne yesterday urged health chiefs to issues clearer guidance to parents over what they should do if they think their child has Strep A.
She said GP surgeries were being deluged by worried parents and struggling to cope on top of existing patient demand.
Professor Hawthorne told the BBC: ‘We do not want to discourage patients who are worried about their children to seek medical attention, particularly given the current circumstances.
‘But we do want to see good public health messaging across the UK, making it clear to parents when they should seek help and the different care options available to them — as well as when they don’t need to seek medical attention.’
She also called for ‘overspill’ services — which could pick up extra demand amid the outbreak — to ease pressures on general practice.
The surge in cases and resulting fears has left the NHS in ‘meltdown’, with parents of sick children swamping GP practices, A&E units and 111 call centres.
Camila Rose Burns (pictured), from Bolton in Greater Manchester, was admitted to hospital 11 days ago and doctors confirmed she was had the usually-mild bacterial infection
Now, the ‘special little’ four-year-old is in the fight for her life. Mr Burns said he’s told her how much everyone loves her, and said everyone is hoping for a miracle
SO SHOULD YOU TAKE YOUR CHILD TO A&E OR A GP?
Fears over Strep A infections in children come as several of winter bugs with similar symptoms are also in active circulation.
While most will resolve without the need for any serious medical intervention, for worried parents the official advice on when, and from whom, to seek help is the following:
As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.
You should contact NHS 111 or your GP if:
- your is sick and 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 38°C, or is older than 3 months and has a temperature of 39°C 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
You should call 999 or go to straight to A&E 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 awak
This is on top of normal winter pressures — which sees extra demand due to the cold weather and flu every year — and more patients needing NHS care due to spikes in flu and RSV.
The Grange University Hospital in Gwent, South East Wales, saw 90 children on Monday night, with some facing 10-hour waits, the Mirror reported.
Dr Robert Stafford, an A&E consultant at the hospital, told the newspaper: ‘We know there are a lot of parents and carers who are anxious about Strep A. But I would urge people to stay calm.’
Meanwhile, the Royal Belfast Hospital for Sick Children yesterday announced that it postponed all routine procedures due to ‘significant pressures’ from the bacterial infection outbreak.
It said more than 200 youngster attended its emergency department on Tuesday alone.
The hospital — which treated five-year-old Stella-Lilly McCorkindale, from Northern Ireland, who died from Strep A this week — said ear, nose and throat procedures are among those being pushed back.
It comes after the UK Health Security Agency this week came under fire for telling parents to keep their child off school and call their doctor if they suspected Strep A.
But the guidance also pointed to a sore throat and headache as symptoms — to ailments that are linked to dozens of mild and non-infectious conditions.
Professor David Livermore, a microbiologist at the University of East Anglia, told MailOnline: ‘A child with a strep A infection certainly should be kept home and given antibiotics.
‘The problem with the Government’s advice is that the great majority of children with a sore throat will have a virus, not strep A. And they’ve missed quite enough school already.’
Professor Paul Hunter, an epidemiologist at the University of East Anglia, told MailOnline that the new advice could see children unnecessarily have time off school.
Pupils will miss classes ‘for a few days’ if their parents think their sore throat could be strep, he said.
Meanwhile, the Dawn Burns, the grandmother of a four-year-old in hospital with Strep A, today warned parents that pain in one part of the body could be a sign of the illness.
Camila Rose Burns, from Bolton, was admitted to hospital nearly a fortnight ago and was left fighting for her life after developing an exceptionally rare complication to the usually-harmless bug.
Ms Burns said Camilla — who is still in intensive care — developed a pain near her shoulder before becoming seriously ill.
Her grandmother told BBC Radio 4’s Today programme this morning: ‘Camilla was complaining of having pain in her chest, in the top left-hand corner, quite near to her shoulder.
‘Pointed that out to the doctor, and the doctor said she has “more than likely” pulled a muscle being sick and coughing.
‘And I think that’s what parents need to look out for — a persistent pain in one part of the body.
‘Because you’ve been told by someone who you trust that it’s a pulled muscle and to give her Calpol, you just trust that that’s the right thing.’
From the ‘bubbly’ seven-year-old whose father desperately tried CPR to save, to the four-year-old who loved exploring: All the victims of Strep A so far
Muhammad Ibrahim Ali
The four-year-old boy attended Oakridge School and Nursery in High Wycombe, Bucks.
He died at home from a cardiac arrest in mid-November after contracting a Strep A infection.
He was prescribed antibiotics.
His mother Shabana Kousar told the Bucks Free Press: ‘The loss is great and nothing will replace that.
‘He was very helpful around the house and quite adventurous, he loved exploring and enjoyed the forest school, his best day was a Monday and said how Monday was the best day of the week.
Muhammad Ibrahim Ali, who attended Oakridge School and Nursery in High Wycombe, Bucks, died after contracting the bacterial infection
The ‘bubbly’ and ‘beautiful’ seven-year-old is the only child to have died from Strep A in Wales so far.
Her devastated parents told how their ‘hearts had broken into a million pieces’.
The first signs of the infection were mild, Hanna’s father Abul took his daughter to the GP after cough got worse overnight.
She was prescribed steroids and sent home, but she died less than 12 hours later.
Mr Roap recalled how he desperately tried to resuscitate his child: ‘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.’
Mr Roap said the family was ‘utterly devastated’ and awaiting answers from the hospital.
The family believe she might have lived if she was initially given antibiotics.
Hanna Roap, who attended Victoria Primary School in Penarth, Wales, died after contracting Strep A last month. Her family say they have been ‘traumatised’ by her death
Five-year-old Stella-Lily McCokindale is the ninth British child to have died following a Strep A infection, and the first in Northern Ireland.
She died on December 5 at Royal Belfast Hospital.
In a tribute on social media, her father Robert said the pair had ‘loved every minute’ of being together as they went on scooter and bike rides.
‘If prays, thoughts, feelings and love could of worked she would of walked out of that hospital holding her daddy’s hand,’ he said.
Stella attended Black Mountain Primary School, who said she was ‘a bright and talented little girl’ and described her death as a ‘tragic loss’.
Five-year-old Stella-Lily McCokindale who attended Black Mountain Primary School in Belfast died in early December after contracting Strep A
Four of the six other deaths include:
- An unidentified six-year-old pupil who attended Ashford Church of England Primary School in England in Surrey.
- A primary school pupil who attended St John’s School in Ealing, west London.
- A 12-year-old boy attending Colfe’s School in Lewisham, south east London.
- An unidentified child at Morelands Primary School in Waterlooville.