Group A Streptococcus (GAS) Infections in children
I understand and empathise with the concern from parents regarding the recent media reports of a surge in the number of cases of group A streptococcus in the UK - Especially the tragic deaths of a number of children with complications of the illness.
I have therefore written down a few thoughts which I hope will be of benefit to parents of young children.
This is not designed to be an exhaustive list, and is certainly not a diagnostic tool or replacement for seeing a doctor with your child. If you have any concerns about your child’s wellbeing, you should seek advice and support via appropriate methods.
Best wishes
Dr Daniel Gordon
Private GP
Group A Streptococcus (GAS) infections are common illnesses
Infections caused by GAS are common, and include tonsillitis, scarlet fever, impetigo and other skin infections. Doctors, especially GPs and paediatricians, are used to seeing children with these infections. They are usually mild illnesses which occur seasonally in Winter and Spring in the UK. For the most part, children with GAS infections get better on their own, however antibiotics are frequently prescribed to treat the illness and minimise the risk of passing on the bacteria to others.
Why have some children become very unwell?
The children mentioned in the media who have developed serious illness have had invasive group A streptococcal (iGAS) infection. This is where the infection enters the bloodstream and causes serious, life-threatening conditions. iGAS infections are thankfully extremely rare, and it is not yet known why there has been an increase in cases recently.
Why is this difficult for parents now?
At this time of year many feverish illnesses are circulating, including flu and respiratory syncytial virus (RSV). Parents with unwell children are understandably anxious about being able to differentiate if their child has a viral infection or something more serious. This is especially the case for illnesses like flu, which can cause children to have high fevers and other symptoms which can also occur in GAS infections.
It is important for parents to remember at this time that the ‘red flag’ warning signs for serious illness remain the same as with other illnesses which affect children. The NHS has published useful leaflets which are available here, and which should be reviewed by all parents with an unwell child at home.
Should parents be concerned?
The overall risk to children is extremely low, however it is worthwhile parents being more vigilant. This is especially the case if you become aware that your child has been in contact with someone with a GAS infection, or if your child has other underlying health problems which make them more susceptible to infections.
What are Dr Gordon’s considerations?
Whenever I see a child who isn’t feeling well, I always conduct a comprehensive check for signs of bacterial infection (including GAS) or serious illness - And this will of course remain the case with the current concerns about GAS infections.
There are a few additional considerations that I, and my other medical colleagues, are likely to put into practice over the next few weeks. It is helpful to highlight those here for parents who may wish to understand in more detail.
Encouraging face to face assessments - I would generally encourage parents to have a lower threshold for seeking a face-to-face assessment with a doctor if their child is unwell. This includes if their child has a suspected viral illness such as a cough or cold which is not resolving in a reasonable time frame.
Keeping a closer eye on your child - If I have seen your child for a feverish illness, I may suggest bringing them for a review appointment within a suitable time frame. This is so that I can assess for any change in the child’s condition over time - A very important part of looking after unwell children.
Arranging a viral swab - In some instances it may be useful to arrange a viral swab during a child’s appointment. This is a swab of the nose and throat, which almost all children are used to having following the pandemic. Just like with COVID-19, we can use these swabs to test for other respiratory viruses such as flu and RSV, which can be useful in confirming a cause for a child’s symptoms.
Arranging a throat swab - In some instances it may be useful to arrange a throat swab, which is one of the best ways to identify if GAS may be behind a child’s symptoms. The downside of throat swabbing is that results usually take 2-4 days, by which time a clinical decision on how to treat the child should have already been made. I would always discuss this with you during your child’s consultation so that the advantages and disadvantages of testing are clear.
Treating ‘just in case’ with antibiotics - In cases which are clinically difficult to distinguish, we may be more likely to suggest antibiotics to cover for the risk of possible GAS infection. I am always keen to avoid prescribing unnecessary antibiotic courses, however this must be balanced against the risk of leaving an infection untreated. This kind of decision is always made on a case-by-case basis by a doctor following a comprehensive assessment and examination of the child.
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