 Group A Streptococcus (GAS), more commonly known as Strep A, is usually found on the skin or throat. It is most prevalent among children aged 5-15 years and adults who are parents of school-aged children are an increased risk group of Strep A. According to The Sun, “there have been over 40 children reported to have died from Strep A in the UK as the deadly infection grows.” In PharmAlliance, we would like to explore causes, prevalence, symptoms and treatment of Strep A in this blog to inform and bring attention to this “deadly infection” to stop its asymptomatic threats from causing more deaths among the younger population. GAS is a type of bacteria that can cause a variety of infections. Strep A infections are highly contagious and are most commonly spread through close contact with an infected person through respiratory droplets or through direct contact with infected skin sores. The symptoms of a Strep A infection can include: flu-like symptoms such as high temperature, swollen glands or an aching body, sore throat, a rash that feels rough, scabs and sores, pain and swelling, severe muscle aches and nausea and vomiting. As of December 2022, there has been an increase in the incidence of strep A in the UK, which has resulted in the NHS experiencing significant pressures, especially during the period where pharmacies were faced with shortages of antibiotics. There have been several theories illustrating potential explanations for the increases in strep A cases. It has been thought that recent increases in strep A cases may be related to the early spikes in influenza and respiratory syncytial virus (RSV) infections, along with the continued spread of COVID-19. This has eventually led to colonization and infection of Strep A bacteria. Strep A infections are also more likely following chickenpox – another viral infection. Another possible theory is that the COVID-19 pandemic has resulted in decreased exposure to strep A infections during lockdown. Hence, a greater number of individuals were prone to this infectious disease as a result of reduced immunity levels. Most cases of strep A are mild and can easily be treated with a course of antibiotics. Strep A generally has non-invasive manifestations such as pharyngitis (sore throat), impetigo and scarlet fever. If the patient is suffering from a sore throat only, the first line treatment in this case is phenoxymethylpenicillin for 5 days or if the disease has progressed to scarlet fever this treatment should be increased to a 10 day period. Phenoxymethylpenicillin is also indicated in the prophylaxis of iGAS (invasive group A streptococcal disease) which occurs when the bacteria spreads to the lungs, bloodstream and in turn other parts of the body. This leads to invasive diseases such as bacteraemia (streptococcal bacteria in the bloodstream), necrotising fasciitis (also known as “flesh eating disease”, as damage is caused to soft tissue) and streptococcal toxic shock syndrome (toxins being released into the body by streptococcal bacteria). In these cases it is essential the patient is treated with IV antibiotics as there is a risk of sepsis or even death. There is no vaccine to protect against strep A. It is important that after a diagnosis of iGAS, close contacts are identified. A close contact is anyone who has “had prolonged contact with the case in a household-type setting during the 7 days before onset of symptoms and up to 24 hours after initiation of appropriate antimicrobial therapy”. High risk contacts such as the elderly and women who are over 37 weeks pregnant should be offered prophylactic antibiotic treatment as soon as possible. If the patient is allergic to penicillin, it may be substituted for clarithromycin. In cases of phenoxymethylpenicillin shortage, amoxicillin, macrolides, flucloxacillin, cefalexin and co-amoxiclav can also be offered. In summary, it is important for us to spot warning signs of Strep A infections among individuals with elevated risks of infections. Common symptoms include fevers, white sores in the throat and sore throat that lasts more than 5 days. We have discussed multiple antibiotic treatment options available above for both mild and severe infections but prevention is always better than cure, especially in the winter when the incidence rate is high. Personal hygiene measures, such as frequent hand washing with soap and water, covering one’s face while coughing and sneezing and avoiding contact with people infected with Strep A infections, can greatly reduce the possibility of infections as Strep A is transmitted through respiratory droplets and skin contact. Written by Peony, Ubaid, Supeedsana, Mumtaj and Alex References https://www.gov.uk/government/publications/invasive-group-a-streptococcal-disease-managing-community-contacts https://www.england.nhs.uk/publication/group-a-streptococcus-communications-to-clinicians/ https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/streptococcus-a-strep-a https://www.nhs.uk/conditions/strep-a/ https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338#:~:text=Strep%20throat%20is%20caused%20by,through%20shared%20food%20or%20drinks. https://www.gavi.org/vaccineswork/whats-behind-recent-surge-strep-and-scarlet-fever https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429 https://www.thesun.co.uk/health/21100770/children-died-strep-uk-cases-infection-grow/
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