Safety alert: managing the risk of increased cases of Group A streptococcus (iGAS)

The latest data from the UK Health Security Agency (UKHSA) shows that scarlet fever cases continue to remain higher than we would typically see at this time of year. Scarlet fever is caused by bacteria called group A streptococci. These bacteria also cause other respiratory and skin infections such as strep throat and impetigo.

On very rare occasions, the bacteria can get into the bloodstream and cause an illness called invasive Group A strep (iGAS). While still uncommon, there has been an increase in invasive Group A strep cases this year, particularly in children under 10.

Group A Streptococcus (GAS; Streptococcus pyogenes) is a bacterium which can develop in the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections, including tonsillitis, pharyngitis, scarlet fever, impetigo, erysipelas, cellulitis and pneumonia.

In rare cases, patients may go on to develop iGAS and can occasionally cause infections that are extremely severe and sometimes fatal. Consequently, Invasive GAS (iGAS) infection and scarlet fever are both notifiable diseases and health professionals must inform local health protection teams of suspected cases. Guidelines are available for the public health management of iGAS cases in the community and healthcare settings and scarlet fever outbreaks in educational settings.

Currently, there is no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria and social mixing.

How to reduce the likelihood of iGAS infection

It’s advisable to look at the following areas in your organisation to help with compliance and to reduce the likelihood of infection:

• iGAS infection and scarlet fever are both notifiable diseases under Notifications of infectious diseases (NOIDs) “Registered medical practitioners in England and Wales have a statutory duty to notify their local authority or local Health Protection Team of suspected cases of certain infectious diseases” (Gov.uk)
• A robust respiratory illness policy should be in place within the organisation
• A suitable and sufficient risk assessment for contamination and infection control should be in place read and understood by workers, if required, for your organisation.
• A thorough routine and additional cleaning schedules should be set in place, reviewed and documented.
• Staff training on infection control, hand hygiene and recognition of signs/symptoms of Strep A should be in place and reviewed where required.

What to look out for in suspected cases of Group A streptococcus (iGAS) and scarlet fever

There are lots of viruses circulating that cause sore throats, colds and coughs. These should resolve without medical intervention. However, children (and occasionally adults) can occasionally develop a bacterial infection on top of a virus and that can make them more unwell. iGAS infection commonly presents as a mild sore throat (‘strep throat’) and skin/soft tissue infections such as impetigo and cellulitis.

In many cases, doctors can diagnose scarlet fever from the symptoms alone. If confirmation is required, they may send a throat swab for bacterial culture to the local microbiology laboratory. In certain cases, serology may also be of value.

What to do as an employer

• Management and staff should be aware of the typical signs and symptoms of Strep A
• Where staff may be suffering from a bad sore throat, headache and fever, along with a fine, pinkish or red body rash with a sandpapery feel they should contact NHS 111 or their GP for further advice.
• Individuals with suspected signs and symptoms should stay away from the workplace and seek medical advice.
• Management should make staff aware of additional control measure put in place and monitor any suspected cases within the organisation.

As an employer in childcare, education, or care settings. Contact NHS 111 or your GP if:

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

Call 999 or go to A&E if:

• The individual is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• There are pauses when the individual breathes
• The individual’s skin, tongue or lips are blue
• The individual is floppy and will not wake up or stay awake

Remember…

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By washing hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell and understanding the additional control contamination and infection control measures put in place staff should be able to reduce the risk of picking up or spreading infections.

iGAS is spread by close contact between individuals, through respiratory droplets (moisture in your breath) and direct skin contact. Regular cleaning routines and rigorous contamination and infection controls are key to help reduce the risk of picking up or spreading infections.

Got questions?

If you have any questions about how to protect your staff and business from the increase in Strep A cases, you can call our Health & Safety advice line 24/7 on 0345 844 4848.