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Streptococcus A (strep A), Scarlet Fever and iGAS

Public Health Wales is reminding parents that cases of invasive group A streptococcal infection (iGAS) remain rare in Wales, and that children have a very low risk of contracting the disease.

In most cases, infection with streptococcal A causes scarlet fever, usually a mild illness.

Frequently Asked Questions (FAQs)

 

What is Strep A, Scarlet Fever and iGAS?
  • Group A streptococcal (GAS) infection is a group of bacteria which causes infections in the throat and skin.
  • Scarlet fever is a contagious infection caused by Group A streptococcal infection that mostly affects young children. It's easily treated with antibiotics.
  • Sometimes severe GAS disease may occur when bacteria get into parts of the body where bacteria are usually not found, such as the blood, muscles or the lungs. These infections are known as invasive Group A Streptococcal disease (iGAS) and may include serious conditions, such as toxic shock syndrome.
 
Why does invasive Group A Streptococcal disease occur?

Invasive GAS infections occur when the bacteria get past the defences of the person who is infected. This may occur when a person has sores or other breaks in the skin that allow the bacteria to get into the tissue, or when the person’s ability to fight off the infection is decreased because of chronic illness or an illness that affects the immune system.

 
Why are we seeing an increase in cases of Scarlet Fever and iGAS?

We are seeing an increase in cases of Scarlet Fever this year and it is presenting itself earlier than normal. This is likely to be as a result of children being more isolated during the Coronavirus pandemic, and now being back in social settings more frequently. Increases in cases of Scarlet Fever may result in more cases of the far rarer iGAS.

 
Should I be concerned?

While we understand that parents are likely to be worried by reports they are seeing related to iGAS, cases of invasive group A streptococcal infection (iGAS) remain rare in Wales, and children have a very low risk of contracting the disease.

In most cases, infection with streptococcal A bacteria causes scarlet fever, usually a mild illness.

Cold and flu like symptoms are very common at this time of year, especially in children.  Most children with these symptoms will have a common seasonal virus, which can be treated by keeping the child hydrated, and with paracetamol.

Some children with cold and flu like symptoms - sore throat, headache, fever - may be experiencing some of the early symptoms of scarlet fever, which also circulates at this time of year.  These children will go on to develop scarlet fever specific symptoms, including a fine pink-red rash that feels like sandpaper to touch, and parents should contact their GP if they see these symptoms.

While scarlet fever is more concerning than a common cold, it is still usually a mild illness from which most children will recover without complications, especially if the condition is properly treated with antibiotics.

In very rare cases, group A streptococcal infection can cause iGAS, a rare complication which affects fewer than 20 children in Wales each year.  Although iGAS is a worrying condition, the majority of these children will recover with proper treatment.

The best thing that parents can do is to provide the care they would usually provide for a child with cold and flu like symptoms, but to familiarise themselves with the symptoms of scarlet fever and iGAS as a precaution

 

What are the symptoms of scarlet fever?

The symptoms of scarlet fever include a sore throat, headache, fever, nausea and vomiting.  This is followed by a fine red rash, which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. Older children may not have the rash.  

On more darkly pigmented skin, the scarlet rash may be harder to spot, but it should feel like 'sandpaper'.  The face can be flushed red but pale around the mouth.

 

What should parents do if their child is showing symptoms of Scarlet Fever?

Parents who suspect their child has symptoms of scarlet fever are advised that they should:

  • See their GP or contact NHS 111 as soon as possible
  • Make sure their child takes the full course of any antibiotics prescribed by the doctor
  • Keep their child at home, away from nursery, school or work and follow any guidance provided by their GP on how long they should remain absent from these settings.
 
What are the symptoms of iGAS?
  • Fever (a high temperature above 38°C)
  • Severe muscle aches
  • Localised muscle tenderness
  • Redness at the site of a wound.

 

What should I do if my child is showing symptoms of iGAS?

Parents are being advised to contact their GP or get medical advice straight away if they think their child has any of the signs and symptoms of iGAS disease.