Antibiotics ‘can be given to groups of children during Strep A outbreaks’

Guidance on scarlet fever outbreaks says antibiotics can be given on a case-by-case basis.

06 December 2022

Local health protection teams can give antibiotics to groups of children where there has been a Strep A outbreak, the deputy director of the UK Health Security Agency (UKHSA) has said.

Dr Colin Brown told Sky News there was “long-standing guidance” that enables health protection teams to assess the situation in schools and nurseries to consider antibiotic prophylaxis for “either a group of children in certain classes or an entire nursery school”.

He reiterated there is no evidence to suggest there had been a change to the circulating strains of Strep A to make them more severe, following the deaths of at least nine children across the UK.

The latest death is a five-year-old child in Belfast who attended a primary school. Health Authorities in Northern Ireland have not yet commented.

Dr Brown suggested that a lack of mixing due to the Covid pandemic plus susceptibility in children are probably “bringing forward the normal scarlet fever season” from spring to this side of Christmas.

He said: “There isn’t something that is particularly new or novel about the bacteria that are causing the infections that we’re seeing at the moment.

“We are seeing a larger number of infections, for example, causing scarlet fever, than we would normally see this time of year.”

Updated guidance on scarlet fever outbreaks, which are caused by Strep A, published by the UKHSA in October sets out how antibiotics can be used as prophylaxis but a decision is taken with local outbreak control teams (OCTs) on “a case-by-case basis”.

It added: “It can be considered in exceptional circumstances by the OCT; for example, when there are reports of severe outcomes, or hospitalisations.”

Strep A bacteria can cause many different infections, ranging 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 serious and life-threatening invasive Group A Streptococcal disease.

This occurs when the bacteria has 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.

Adam Finn, professor of paediatrics at the University of Bristol, told Times Radio that people are right to be worried and “it’s an enormous tragedy for these families”.

He added: “We’re not used, in our society, to losing the lives of previously healthy children – this is something that’s very shocking and concerning.

“What we’ve got to do is get the balance right here; on the one hand not alarm people whose children are mildly ill – and there are a lot of mildly ill children around at the moment – and at the same time help people and support people to seek care and attention when their children become seriously ill, relentlessly sicker and sicker as the hours go by. Those are the children that need to be urgently seen.”

He said children with “run-of-the-mill” viral infections can feel unwell and then better again, and “things go up and down”, and they continue to eat and drink.

“Children who’ve got invasive bacterial infection, they don’t have those episodes of feeling better – they just get worse and worse,” he said.

“They stop eating, they stop responding, they sleep a lot. They might complain, if they are awake, of aches and pains and headaches.

“They might have a rash or a sore throat or tummy ache, but they just get sicker and sicker.

“When you see that progressive decline, that’s the time to get the child to medical attention.”