Streptococcus A (Strep A)
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Group A Streptococcus (GAS) – also known as Streptococcus pyogenes – are bacteria commonly found on the skin or in the throat, where they can live without causing problems. Under some circumstances, however, these bacteria can cause disease.
GAS bacteria can cause a wide variety of skin, soft tissue and respiratory tract infections ranging in severity from mild to life-threatening. These include:
- tonsillitis
- sore throat
- scarlet fever
- impetigo
- erysipelas (a type of cellulitis)
- cellulitis
- pneumonia
- meninigitis
- septic arthritis
The most common presentations of GAS infection are a mild sore throat ('strep throat') and skin/soft tissue infections such as impetigo and cellulitis.
If you have a sore throat or tonsillitis some pharmacies are offering a Test and Treat service for some types of conditions. You can search for a participating pharmacy here.
In rare cases, patients may go on to develop post-streptococcal complications, such as:
- rheumatic fever
- glomerulonephritis (heart and kidney diseases caused by an immune reaction to the bacteria).
However, GAS can cause more serious invasive infections (referred to as iGAS infections) such as bacteraemia (an infection of the bloodstream), necrotising fasciitis (a severe infection involving death of areas of soft tissue below the skin) and streptococcal toxic shock syndrome (rapidly progressive symptoms with low blood pressure and multi-organ failure).
iGAS infections are most common in the elderly, the very young or people with an underlying risk factor such as injecting drug use, alcoholism, immunosuppression or cancer.
GAS is spread by close contact between individuals, through respiratory droplets and direct skin contact.
It can also be transmitted environmentally, through contact with contaminated objects, such as towels or bedding or ingestion of food inoculated by a carrier.
Things you can do yourself
The best thing that parents can do is to provide the care they would usually provide for a child with cold and flu like symptoms, and to familiarise themselves with the symptoms of scarlet fever and iGAS as a precaution.
If you are worried about Strep A, please visit Public Health Wales's FAQs page
Symptoms of scarlet fever
The symptoms of scarlet fever include a sore throat, headache, fever, nausea and vomiting. This is followed by a fine red rash, which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. Older children may not have the rash.
On more darkly pigmented skin, the scarlet rash may be harder to spot, but it should feel like 'sandpaper'. The face can be flushed red but pale around the mouth.
Find out more about scarlet fever
Symptoms of invasive GAS
- Fever (a high temperature above 38°C)
- Severe muscle aches
- Localised muscle tenderness
- Redness at the site of a wound
When should you worry?
If your child has any of the following:
- Is pale, mottled and feels abnormally cold to touch
- Has blue lips
- Too breathless to talk / eat or drink
- Has a fit/seizure
- Is extremely agitated (crying inconsolably despite distraction), confused of very lethargic (difficult to wake)
- Has dark green vomit
- Has a rash that does not disappear with pressure (the 'Glass Test')
- Is under 1 month of age with a temperature of of 38°C/100.4°F or above
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
- Is finding it hard to breath
- Unable to swallow saliva
- Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours)
- Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
- Has extreme shivering or complains of muscle pain
- Develops a painful, red swollen gland in their neck which is increasing in size
- Is 1-3 months of age with a temperature of of 38°C/100.4°F or above, or 3-6 months of age with a temperature of 39°C/102.2°F or above (but fever is common in babies up to two days after they receive vaccinations)
- Continues to have a a fever of 38°C or above for more than 5 days
- If your child has recently had scarlet fever but now appears to have a puffy face/eyelids, tea 'coca-cola' coloured urine (pee), or a swollen, painful joint(s)
- Is getting worse or if you are worried
You need to contact a doctor or nurse today.
Please ring your GP surgery or call NHS 111 - dial 111
If symptoms persist and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.
If none of the above features are present
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Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
What should you do?
If you think your child has scarlet fever, they should be seen by their GP. They may need treatment with antibiotics.
To make your child more comfortable, you may want to lower their temperature using paracetamol (calpol) and/or ibuprofen. Use one and if your child has not improved 2/3 hours later you may want to try giving the other medicine. However, remember that fever is a normal response that may help the body to fight infection and paracetamol/ibuprofen will not get rid of it entirely.
Avoid tepid sponging your child - it doesn't actually reduce your child's temperature and may cause your child to shiver.
Encourage them to drink plenty of fluids.
Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections. So remember to:
Catch it: always cough or sneeze into a tissue
Bin it: always throw the used tissue in a bin
Kill it: always wash your hands with soap and hot water
How long will your child's symptoms last?
The sore throat and fever often last for about 3-6 days and the rash usually improves within a week. Antibiotics reduce the length of fever/sore throat by about 1 day.
Children commonly experience peeling of their fingers and toes after scarlet fever.
Your child is no longer infectious to others (contagious) after 24 hours of starting antibiotics and can go back to school/nursery if they feel well enough.
Where should you seek help?
- If it is non-urgent, speak to your local pharmacist or health visitor.
- If your child has any of the above features, urgently see your GP. For an urgent out-of-hours GP appointment, call NHS 111 Wales.
- You should only call 999 or go your nearest A&E department in critical or life threatening situations.
For wear and tear, minor trips and everything in between.
Self-care
You can treat your child's very minor illnesses and injuries at home.
Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
For wear and tear, minor trips and everything in between.
Self-care
You can treat your child's very minor illnesses and injuries at home.
Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.
Sound advice
Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.
Sound advice
- Visit a pharmacy if your child is ill, but does not need to see a GP.
- Remember that if your child's condition gets worse, you should seek further medical advice immediately.
- Help your child to understand - watch this video with them about going to the pharmacy.
For information on common childhood illnesses go to What is wrong with my child?
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.
Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.
Contact them by phoning your Health Visitor Team or local Children’s Centre.
Sound advice
Health visitors also provide advice, support and guidance in caring for your child, including:
- Breastfeeding, weaning and healthy eating
- Exercise, hygiene and safety
- Your child’s growth and development
- Emotional health and wellbeing, including postnatal depression
- Safety in the home
- Stopping smoking
- Contraception and sexual health
- Sleep and behaviour management (including temper tantrums!)
- Toilet training
- Minor illnesses
For more information watch the video: What does a health visitor do?
Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.
Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.
Contact them by phoning your Health Visitor Team or local Children’s Centre.
Sound advice
Health visitors also provide advice, support and guidance in caring for your child, including:
- Breastfeeding, weaning and healthy eating
- Exercise, hygiene and safety
- Your child’s growth and development
- Emotional health and wellbeing, including postnatal depression
- Safety in the home
- Stopping smoking
- Contraception and sexual health
- Sleep and behaviour management (including temper tantrums!)
- Toilet training
- Minor illnesses
For more information watch the video: What does a health visitor do?
School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.
Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.
There is also a specialist nurse who works with families who choose to educate their children at home.
Sound Advice
Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.
They all have a role in preventing disease and promoting health and wellbeing, by:-
- encouraging healthier lifestyles
- offering immunisations
- giving information, advice and support to children, young people and their families
- supporting children with complex health needs
Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.
School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and/or emotional health needs.
Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.
There is also a specialist nurse who works with families who choose to educate their children at home.
Sound Advice
Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.
They all have a role in preventing disease and promoting health and wellbeing, by:-
- encouraging healthier lifestyles
- offering immunisations
- giving information, advice and support to children, young people and their families
- supporting children with complex health needs
Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.
