What is Strep A: Symptoms, severity and spread explained as outbreaks hit Northern Ireland

Northern Ireland's Public Health Agency is urging parents and guardians to be alert for the signs of Group A streptococcal – otherwise known as Strep A – infections.

But it has ruled out school closures to contain the spread.

UK health authorities are dealing with outbreaks of the bacteria, which usually causes a mild infection – but can cause serious problems if it enters the bloodstream.

The PHA also says Northern Ireland is seeing a higher number of cases of scarlet fever than is usual for this time of year, which can lead to Strep A.

Parents are advised to contact their GP is they think their child has scarlet fever as early treatment with antibiotics is important to reduce further complications.

What is Strep A?

Strep A is a bacterium which can colonise the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections.

Those carrying the bacteria may have no symptoms or develop an infection.

It survives long enough in the throat or skin to allow it to be spread by skin-to-skin contact, coughing and sneezing.

Even in cases where a person has no symptoms, carriers of the disease can still pass on Strep A as easily as those who are feeling ill from it can.

What are the main symptoms of Step A?

Strep A is a highly contagious bacterial infection that can be extremely serious, but is treatable. It can cause a lot of different illness, but tends to begin with a few typical symptoms.

These symptoms include:

• A rash

• Sore throat

• Flushed cheeks

• A swollen tongue

• Severe muscle aches

• High fever

• Localised muscle tenderness

• Redness at the site of a wound.

It is spread through coughs and sneezes with cases most common during the winter period.

What should you do if you or your child has signs of strep A?

The Public Health Agency says those with symptoms should call their GP.

However, parents should call 999 or go to the Emergency Department 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 awake.

How contagious is strep A and how do you catch it?

Group A strep bacteria are very contagious.

Generally, people spread the bacteria to others through respiratory droplets, such as through sneezing, coughing or talking, and direct contact.

Rarely, people can spread group A strep bacteria through food that is not handled properly.

It usually takes someone two to five days for someone exposed to strep A bacteria to become ill.

Are there risk factors which make someone more susceptible to contracting strep A?

Strep throat is more common in children than adults.

It is most common in children aged five to 15.

The illness is very rare in children younger than three-years-old.

Another key risk factor is close contact with another person with the condition.

For instance, if one person in a household has the condition, the bacteria can more easily spread to other members of that household.

This is why there is a greater risk in crowded settings such as schools and nurseries when one person in that environment has the infection.

People with weakened immune systems can also have a higher chance of coming down with strep A, including those with HIV, AIDS or cancer, or anyone who has had an organ transplant.

How can you avoid catching strep A?

The best way to cut down your risk of contracting strep A is to avoid contact with anyone who has the virus.

In addition, you should avoid sharing personal items, such as toothbrushes, cups and cutlery, with unwell individuals.

Washing your and and your children's hands often and using alcohol-based sanitiser can also reduce risk.

Is strep A unusual? Are we hypersensitive to the virus after Covid?

The recent strep A outbreak is rare according to the UK Health Security Agency (UKHSA).

The UKHSA's most recent report, updated on 20 September, on strep A infections found recent notification levels were below average compared to the past four seasons, but were showing a usual seasonal increase.

The UKHSA said: "While increases in severe presentations in children have not been seen so far this season, it remains important that scarlet fever cases are treated promptly with antibiotics to limit further spread, and reduce risk of potential complications in cases and household contacts."

Why isn't closing schools an option to prevent spread?

Dr Philip Veal of the PHA explained that evidence from previous infectious disease outbreaks show that school closures were generally ineffective ways of controlling the spread of infections. He said children and young people tend to still congregate in larger groups even when not in school, and the closure of schools often means that to children are cared for by grandparents. This leads to older and more vulnerable people being exposed to potential infection, and therefore increases the risk of fatality. The PHA said other methods of control practices are more effective, such as the use of tissues to catch sneezes and coughs, regular thorough washing of hands and parents keeping children off of school if they have symptoms of a Strep A infection. Why does the PHA think there has been an outbreak in NI?

The Strep A outbreak is occurring at an unusual time of year; health officials normally expect to see the disease spike in spring. There are several theories being considered as to why there is an outbreak this time of year. A change in people's social mixing patterns after two years of restrictions is one theory. The rise may also reflect a change in the natural immunity levels of children who were raised during the years of lockdowns. Children's immune systems develop through being exposed to a range of illness in the early years of their lives. During the height of the Covid pandemic however, children spent much less time mixing with large groups of people, and therefore may have been exposed to fewer illnesses, giving their natural immunity less time to develop.

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