Primary school children at risk from a severe form of strep A could be given preventive antibiotics as a blanket measure, in a move described as “rare” by health officials.
At least nine children have died due to complications from strep A bacterial infections since September, with one senior health official suggesting the early start to the strep A season in the UK could be a knock-on effect to immunity levels caused by Covid measures, although others have downplayed the effects lockdowns may have had.
Most strep A infections are mild, with a sore throat or a skin infection that can be easily treated with antibiotics the most common characteristics, and deaths are rare.
In extreme cases, strep A can develop into an invasive group A streptococcal infection (iGAS), which can be fatal. Officials have noticed an increase in iGAS cases this year, particularly in children under 10.
On Tuesday, the schools ministers, Nick Gibb, told GB News preventive antibiotics could be given to children in England at schools affected by strep A infections.
He said: “Lord Markham said in the House of Lords yesterday that the UK Health Security Agency are monitoring the position and are considering those kind of issues in those schools where there is an infection.
“This is an ongoing situation, the UKHSA are involved very closely with those schools and they will be providing further advice later on. But that may well be an option for those particular schools where there is an infection.”
The plan was floated by the health minister Nick Markham in the Lords on Monday.
The Conservative peer said: “We have given instructions to doctors that where necessary they should be proactively prescribing penicillin as the best line of defence on this, and also where there is a spread in primary schools, which we know is the primary vector for this, whether they should be working with local health protection teams, and sometimes actually look at the use of antibiotics on a prophylactic basis.”
GPs generally avoid mass prescription of antibiotics as it can build up resistance to serious infections in the population.
The UKHSA said the measure of prescribing antibiotics to children in a school or nursery exposed to non-invasive strep A was “rare”.
The agency added the move was only considered in “exceptional circumstances” by the outbreak control team (OCT) on a “case-by-case basis”.
“There is no good evidence of (antibiotics’) effectiveness in routine outbreak control in this setting (involving children who have been contacts of non-invasive strep A),” the UKHSA said.
“It can be considered in exceptional circumstances by the OCT, for example when there are reports of severe outcomes, or hospitalisations. In school and nursery settings, antibiotic chemoprophylaxis is not routinely recommended for contacts of non-invasive (group A streptococcus) GAS infection.”
A pupil at Morelands primary school in Waterlooville, Hampshire, became the eighth child known to have died with the invasive form of strep A. On Tuesday it was reported a ninth child had died in Northern Ireland.
Adam Finn, a professor of paediatrics at the University of Bristol, told Times Radio that it was important to “get the balance right”.
“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 could 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.
Illnesses caused by the group A strep bacteria include the skin infection impetigo, scarlet fever and strep throat.
There has been a big increase in scarlet fever cases. There were 851 reported from November 14 to 20, compared with an average of 186 for the same timeframe in previous years.
Symptoms of scarlet fever include sore throat, headache and fever, along with a fine, pinkish or red body rash with a “sandpapery” feel.
