Parents are being asked to be on the lookout for signs of strep A infection after reports a ninth child has died from the bacterial infection in the UK.
Group A Streptococcus is the name given to a type of bacteria sometimes found in the throat or on the skin.
According to the NHS it usually causes mild illness like sore throats and skin infections. Rarely these bacteria can cause severe and life threatening illness called invasive Group A Streptococcal disease.
While it is treatable with antibiotics (usually penicillin) and is typically mild, it can lead to complications such as scarlet fever, or a severe infection (when the bacteria enters parts of the body that are usually free from bacteria such as the lungs, blood or muscles).
The most recent deaths come after the UK Health Security Agency (UKHSA) reported on Friday there had been five deaths in England, in addition to a death in Wales, and issued a rare alert over the rise in cases.
Downing Street has urged parents and carers to be on the "lookout" for symptoms after the rise in the number of cases but with some people showing no signs of the infection, there is concern about how to know if your child is suffering.
Watch: The schools minister has confirmed antibiotics may be given to children if there's a Strep A outbreak at their school
Dr Susan Hopkins, chief medical adviser at the UK Health Security Agency, said the UKHSA is “concerned” by a premature spike in cases, and said immunity could be lower following lockdown restrictions.
"We're seeing a rise in the number of cases of both scarlet fever and invasive group A strep," she told BBC Radio 4’s Today programme.
"The numbers that we're seeing each week are not as high as we would normally see at the peak of the season, but they are much, much higher than we have seen at this time of year for the last five years.
"So we're concerned, and concerned enough to ensure that we wanted to make the public aware of the signs and symptoms that they should watch out for, and of course, to alert clinicians to prescribe antibiotics for these conditions."
She says an early start to the strep A infections season in the UK could be a side effect of the easing of pandemic restrictions.
"We are back to normal social mixing and the patterns of diseases that we are seeing at the moment are out of sync with the normal seasons, as people mix back to normal and move around and pass infections on," she explained.
What is Strep A?
Strep A bacteria can cause many different infections, ranging from minor illnesses to serious and deadly diseases.
The bacteria are commonly found in the throat and on the skin, and some people have no symptoms.
Infections cause by Strep A include the skin infection impetigo, scarlet fever and strep throat. Scarlet fever in particular has seen a recent surge in cases.
While the vast majority of infections are relatively mild, sometimes the bacteria cause life-threatening illness called invasive Group A Streptococcal disease.
Signs and symptoms of Strep A
Dr Hopkins went on to talk through the signs and symptoms parents should try to be alert to.
1. A sore throat that doesn't ease with painkillers
"When an individual or child has a sore throat, then the first thing parents do is give them painkillers to reduce that sore throat," Dr Hopkins explains. "If that doesn't work, then that's a concerning in itself."
2. A fever that doesn't come down with medication
As with the sore throat, parents should be alert if their child's fever doesn't come down after taking medication.
3. A "sandpaper" type rash
According to Dr Hopkins scarlet fever is characterised by a rash and that rash is not like a normal viral rash. "It feels like sandpaper on skin so if the child's skin feels like sandpaper, rough rather than just a little bit of pinkness to the skin, then that's concerning and it could be scarlet fever," she adds.
4. A "strawberry" tongue
Dr Hopkins advises looking at your child's tongue. "With scarlet fever we describe what's called a strawberry tongue where there's a little bit of a white coating on it, and it looks like a strawberry, bright red," she explains. "That's a warning sign, so parents should look out for that."
If your child is more sleepy or drowsy than usual or difficult to wake up, Dr Hopkins says this is also a concern.
6. Blue hands and feet or lips
If a child's peripherals, including their hands and feet, are blue this could be another warning sign.
7. Not eating and drinking
"If they're not eating or drinking for a number of days particularly if they are dehydrated so if a child is not having a wet nappy, or if children don't want to go to the toilet, then that's a concerning sign as well," Dr Hopkins adds.
What to do if you're concerned about your child
Dr Hopkins says parents should be alert to all the signs listed above and bring them to the attention of their GP or the NHS for initial advice.
"And of course if they're very concerned they should bring them to the emergency department," she adds.
The UKHSA advises that if a parent believes their child seems seriously unwell, they should trust their own judgement.
Contact NHS 111 or your GP if:
your child 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
Call 999 or go 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 awake
Good hand and respiratory hygiene is important for stopping the spread of many bugs, including Strep A.
The government advises 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.
This could help to reduce the risk of picking up or spreading infections.
Additional reporting PA.