Sunday, 4 Jun 2023

Now Europe gets hit by Strep A

Strep A hits Europe: Health chiefs warn of spike in children becoming seriously ill with usually-mild bug in wake of Covid

  • Spike in cases ‘several fold-higher than pre-pandemic levels’ logged in France
  • Ireland, Spain, Sweden and the Netherlands have also seen rise, the WHO says 
  • The infection, which is usually mild, has so far killed at least 16 children in the UK

Strep A cases are surging across Europe, health officials have confirmed in the first sign that it’s not just the UK being hit by unusually high levels of the bug.

A spike in cases ‘several fold-higher than pre-pandemic levels’ have been logged in France and the UK. Ireland, the Netherlands, Spain and Sweden have also reported upticks, according to the World Health Organization.

The bacterial infection, which is usually mild, has so far killed at least 16 children in the UK. Although low, the toll is higher than expected for this time of year.

It comes as officials warn companies supplying the vital antibiotics used to treat the infection they face potentially being fined if they are found to be inflating prices.

What is Strep A?

Group A Streptococcus (Group A Strep or Strep A) bacteria can cause many different infections.

The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.

Infections caused by Strep A range from minor illnesses to serious and deadly diseases.

They include the skin infection impetigo, scarlet fever and strep throat.

While the vast majority of infections are relatively mild, sometimes the bacteria cause an illness called invasive Group A Streptococcal disease.

What is invasive Group A Streptococcal disease?

Invasive Group A Strep disease is sometimes a life-threatening infection in which the bacteria have invaded parts of the body, such as the blood, deep muscle or lungs.

Two of the most severe, but rare, forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.

Necrotising fasciitis is also known as the ‘flesh-eating disease’ and can occur if a wound gets infected.

Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure/shock and damage to organs such as the kidneys, liver and lungs.

This type of toxic shock has a high death rate.


Strep A bacteria can cause a myriad of infections, including impetigo, scarlet fever and strep throat.

While the vast majority of infections are relatively mild, sometimes the bacteria can, in exceptionally rare cases, cause invasive Group A Streptococcal (iGAS) — a life-threatening complication.

Two of the most severe, but rare, forms of this invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.

In a joint statement, the WHO and the European Centre for Disease Prevention and Control (ECDC) warned about the increase in iGAS among under-10s since September.

However, it noted only some European countries inform it of Strep A and iGAS infections, so cases may be more widespread.

Cases of Strep A usually peak during the winter months and early spring. 

But in Britain and France, cases of iGAS in recent months have been ‘several-fold higher than pre-pandemic levels’. 

The UK has logged 169 iGAS infections among children aged 14 and under since September. 

Data from the UK Health Security Agency (UKHSA) suggests this is up to five times higher than this point in the last bad year.

The UK, Ireland, France and Spain have all reported deaths among children.

The WHO gave no indication whether more children are dying than expected for this time of year.

But the UKHSA, which is probing Britain’s ongoing outbreak, said this year’s death toll is unusually high.

The WHO noted that the surge in Strep A came after a ‘period of reduced incidence of infections’ during the pandemic. 

There is usually a surge in iGAS cases every three to four years but social distancing during the Covid pandemic is thought to have interrupted this cycle. 

This has left some youngsters with reduced immunity to Strep A — with a high number of children never having encountered the bacteria in their lifetime — some have suggested.

High rates of other respiratory viruses — including flu, RSV and norovirus — may also be putting children at higher risk of co-infections with Strep A, leaving them more susceptible to severe illness, the WHO said.

It confirmed the surge is not linked to a new strain or an increase in antibiotic resistance.

The outbreak poses just a low risk to the public due to the ‘relatively low’ number of cases, the infection is generally easy to treat and no new strain is in circulation, the WHO said.

But it warned all European nations to be ‘vigilant’ for a similar rise in cases as seen in some nations.

Dr Hans Kluge, WHO regional director for Europe, called on countries to ‘increase vigilance to iGAS cases, especially when respiratory viruses are widely circulating in children’. 

The map shows the rate of iGAS per 100,000 people in England between September 12 and December 4. Rates were highest in Yorkshire (1.8) and the South East (1.4)

The UKHSA has logged 6,601 cases of scarlet fever — which is caused by Strep A — between September 12 and December 4 (green line). For comparison, just 2,538 cases had been reported by this point in 2017/18 (thin blue line), which was considered a ‘bad’ season

Between September 12 and December 4, the UKHSA was notified of 659 iGAS cases (grey line). Rates are currently higher than the previous five winters


Fears over Strep A infections in children come as several of winter bugs with similar symptoms are also in active circulation. 

While most will resolve without the need for any serious medical intervention, for worried parents the official advice on when, and from whom, to seek help is the following:

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. 

You should contact NHS 111 or your GP if:  

  • your is sick and is getting worse
  • your child is feeding or eating much less than normal
  • your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
  • your baby is under 3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher
  • your baby feels hotter than usual when you touch their back or chest, or feels sweaty
  • your child is very tired or irritable

You should call 999 or go to straight to A&E 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 awak

The agency noted that early treatment ‘can be life-saving’, so national health agencies should boost awareness among the public and doctors.

It also encouraged the ‘prompt testing and treatment’ of Strep A infections and for close contacts to be ‘managed’.

Dr Andrea Ammon, director of the ECDC, noted that iGAS ‘can be managed easily if detected in a timely manner’. 

The WHO urged countries to boost vaccination against Covid and flu — as avoiding these viruses will likely reduce the risk of a child developing iGAS. 

Schools should also ensure good hand hygiene and ventilation is in place to reduce the risk of transmission, it added. 

It comes as experts warn that the surge in the winter bug could put vulnerable elderly people at risk of getting Strep A from their grandchildren over Christmas.

While 16 deaths were confirmed in the UK by Friday — 14 in England and one each in Wales and Northern Ireland — there has also been 23 among older people.

Professor Paul Hunter, an epidemiologist at the University of East Anglia, said: ‘There has been a lot of focus on Group A Strep in children but it is worth remembering it can kill at both ends of the age spectrum.

‘Christmas is a time when older people and their grandchildren come together and mix.

‘So families with elderly, vulnerable grandparents should think about the risk from Strep A, particularly if there is a child who has a sore throat right before Christmas, and perhaps rethink their plans.

‘The risk is not huge but one to be aware of, and older people should make sure they have their flu jabs.’

It comes as parents across the UK face difficulties getting antibiotics for sick children amid the Strep A outbreak.

Phenoxymethylpenicillin, amoxicillin and clarithromycin are three antibiotics used to treat Strep A infections. Children are usually given them as a syrup.

Health chiefs have advised doctors to have a ‘low threshold’ for prescribing these to youngsters who have suspected Strep A. 

But a Mail on Sunday survey of chemists found that most had no or very low supplies of liquid penicillin. Pharmacies are now asking GPs for fresh prescriptions for tablets they can crush up.

Pharmacists have said the medicine is ‘flying off the shelves’, leaving them with none left and unsure when they will get more — labelling it a ‘national shortage’.

It contrasts with the message in recent days from officials, who have repeatedly stated there is no supplier shortage.

On top of the shortage, pharmacists claim wholesalers are inflating prices. 

The cost of amoxicillin syrup rose more than fourfold in a month, one East of England chemist said, providing screenshots showing a 100ml bottle at a strength for older children was £2.49 in mid-November but £11.22 now. 

The NHS pays pharmacies £2.69 to dispense it.

Midlands chemist Raza Ali said it was ‘profiteering’, adding that some pharmacists suspect wholesalers are hoarding stock to drive demand and raise prices.

But drug wholesalers have blamed manufacturers — explaining that the price they charge wholesalers will be reflected in the price wholesalers charge chemists. 

The surge in prices led the Department of Health to tell warn suppliers that they risk being referred to the competition regulator — which can dish out fines to companies that abuse their dominant position.

In other related news…  

An expert has blamed the GP appointment crisis for fuelling the UK’s unusually bad Strep A outbreak 

A five-year-old disabled girl, with tell-tale Strep A symptoms, was left without antibiotics for 24 hours after pharmacies were left ‘out of stock’ amid outbreak

A 12-year-old girl in Hove, Sussex, has become the UK’s 16th Strep A death this winter

From the ‘bubbly’ seven-year-old whose father desperately tried CPR to save, to the four-year-old who loved exploring: All the victims of Strep A so far

Muhammad Ibrahim Ali

The four-year-old boy attended Oakridge School and Nursery in High Wycombe, Bucks.

He died at home from a cardiac arrest in mid-November after contracting a Strep A infection.

He was prescribed antibiotics.

His mother Shabana Kousar told the Bucks Free Press: ‘The loss is great and nothing will replace that. 

‘He was very helpful around the house and quite adventurous, he loved exploring and enjoyed the forest school, his best day was a Monday and said how Monday was the best day of the week.

Muhammad Ibrahim Ali, who attended Oakridge School and Nursery in High Wycombe, Bucks, died after contracting the bacterial infection

Hannah Roap 

The ‘bubbly’ and ‘beautiful’ seven-year-old is the only child to have died from Strep A in Wales so far.

Her devastated parents told how their ‘hearts had broken into a million pieces’. 

The first signs of the infection were mild, Hanna’s father Abul took his daughter to the GP after cough got worse overnight. 

She was prescribed steroids and sent home, but she died less than 12 hours later. 

Mr Roap recalled how he desperately tried to resuscitate his child: ‘She stopped breathing at 8pm but we were not immediately aware because she was sleeping.

‘I did CPR, I tried to revive her but it didn’t work. Paramedics arrived and continued the CPR but it was too late.’   

Mr Roap said the family was ‘utterly devastated’ and awaiting answers from the hospital.

The family believe she might have lived if she was initially given antibiotics. 

Hanna Roap, who attended Victoria Primary School in Penarth, Wales, died after contracting Strep A last month. Her family say they have been ‘traumatised’ by her death

Stella-Lily McCorkindale

Five-year-old Stella-Lily McCokindale is the ninth British child to have died following a Strep A infection, and the first in Northern Ireland. 

She died on December 5 at Royal Belfast Hospital.

In a tribute on social media, her father Robert said the pair had ‘loved every minute’ of being together as they went on scooter and bike rides.

‘If prays, thoughts, feelings and love could of worked she would of walked out of that hospital holding her daddy’s hand,’ he said.  

Stella attended Black Mountain Primary School, who said she was ‘a bright and talented little girl’ and described her death as a ‘tragic loss’. 

Five-year-old Stella-Lily McCokindale who attended Black Mountain Primary School in Belfast died in early December after contracting Strep A

Five of the 13 other deaths include:

  • An unidentified six-year-old pupil who attended Ashford Church of England Primary School in England in Surrey.
  • A primary school pupil who attended St John’s School in Ealing, west London. 
  • A 12-year-old boy attending Colfe’s School in Lewisham, south east London. 
  • An unidentified child at Morelands Primary School in Waterlooville
  • A 12-year-old girl from Sussex who attended Hove Park School

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