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

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 is “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 has 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 was of Stella-Lilly McCorkindale in Belfast who attended Black Mountain Primary School. The school spoke of its “tragic loss” and said, “the thoughts of the entire school are with the pupil’s family and friends at this difficult time”.

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.”

The UKHSA has advised medics to have a low threshold for prescribing antibiotics for children who may be suffering infection linked to Strep A.

On Friday, it said GPs should also “maintain a low threshold for prompt referral” to hospital of any children presenting with persistent or worsening symptoms.

Later, in the Commons, Health Secretary Steve Barclay said the NHS is “seeing an earlier peak than usual in terms of cases” of Strep A.

“We believe this is due to lower exposure during the pandemic which has then (meant) to lower immunity. There is no new strain and that I think is one of the key points in terms of reassurance, but the UK Health Security Agency (UKHSA) has declared a national standard and that enables them to better co-ordinate our response including across schools.”

Health minister Maria Caulfield also sought to reassure people over access to GPs and the availability of antibiotics, saying: “We did hold a cross-party briefing for MPs last night on Strep A.

“We want to reassure parents if their children do have symptoms and they are concerned to seek help – GPs are ready, A&E departments are ready and also we have directors of public health proactively going into schools where there are cases.

“There is no shortage of antibiotics we want to reassure people on that and we’re keeping an eye on that on a daily basis.”

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 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.

Meanwhile, St Peter’s Elwick Church of England Primary School near Hartlepool said two children have been confirmed to have Strep A.

The school wrote to parents on Monday assuring them staff were following public health advice and urged them to seek medical help if they were worried about their child’s health.

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.”