December 15, 2022
Overview:
As of December 8th, 2022, at least five Member States in the European Region have notified WHO of an increase in the number of cases of group A streptococcal disease and some cases of scarlet fever as well. An increase in deaths associated with group A streptococcus has also been reported in some of these countries. Children under 10 are the most affected age group.
Epidemic Spread:
- In 2022, France, Ireland, Netherlands, Sweden and the United Kingdom of Great Britain and Northern Ireland recorded an increase in the incidence of group A streptococcal disease and scarlet fever, particularly noticeable in the second half of the year.
- In France, since mid-November 2022, doctors have reported to the Public Health Agency of France and regional health agencies an unusual increase in number of group A streptococcal cases and detection of cluster cases. The agency also revealed an increase in reported cases of scarlet fever in outpatient clinics therein since September 2022.
- On December 6th, the Irish Surveillance Centre for Health Protection reported an increase in group A streptococcal cases in Ireland since the beginning of October. In 2022, as of 8 December, 57 cases of group A streptococcus infection have been reported to the Irish Surveillance Centre for Health Protection, including 15 in children under 10 years of age.
- Dutch Public Health Agency has detected an increase in group A streptococcal infections among children from March 2022 onwards.
- In Sweden, since October 2022, an increase in number of group A streptococcal cases has been observed in children under 10, compared to pre-COVID-19 levels for the same period.
- According to UK's Health Security Agency, notifications increased from mid-September to early December. As of December 8th, 2022, UK has reported 13 deaths within seven days of a diagnosis of group A streptococcus in children under 15 years of age in England.
Epidemiological characteristics of group A streptococcus:
- Group A streptococci are a group of Gram-positive bacteria that can settle in the human throat or skin; It is responsible for more than 500,000 deaths annually worldwide.
Infection:
- Transmission of the infection occurs through close contact with an infected person, and it can be transmitted by coughing, sneezing, or touching a wound.
Symptoms:
- Group A streptococcal infection usually causes mild symptoms, such as high fever, weakness, tonsillitis, pharyngitis, and cellulitis, and may develop symptoms of what is called scarlet fever (when a red rash appears and the tongue becomes red and turns scarlet in colour) Hence the name scarlet fever. Group A streptococcal infection can be easily treated with antibiotics, and a person with mild disease ceases to be contagious 24 hours after treatment.
- In rare cases, or if treatment is delayed, group A streptococcal infection can lead to life-threatening conditions such as necrosis, streptococcal toxic shock syndrome (septicaemia) and other severe acute infections in addition to post-infective immune diseases, such as rheumatic kidney and heart infections.
- Group A streptococcus is a common cause of bacterial pharyngitis in school-age children, and it may also affect younger children. The incidence of pharyngitis, caused by group A streptococcus, usually peaks in winter and early spring months. Outbreaks in kindergartens and schools are common.
Diagnosis and treatment:
- Pharyngitis caused by group A streptococcus is diagnosed by rapid antigen tests (rapid strep test) or culture, and is treated with antibiotics and supportive care. Good hand hygiene and general personal hygiene can help control transmission.
WHO Recommendations:
- World Health Organization recommends that all countries beware of a similar rise in the number of cases, especially in light of the continuing increase in the spread of respiratory viruses that is now occurring across Europe and a number of countries in the world.
- Because of the potential for severe infections, it remains important that infections associated with group A streptococcus, including scarlet fever and streptococcal toxic shock syndrome, are identified and promptly treated with antibiotics to reduce the risk of potential complications and reduce transmission.
- Countries should report to WHO any unexpected increase in national or regional incidence of group A streptococcal infection through IHR or similar mechanisms.
- WHO encourages countries to implement public health communication activities and messages to health care providers, to ensure proper clinical evaluation and diagnostic testing of patients with symptoms consistent with group A streptococcal infection, and prompt treatment of infected patients.
- Health care providers should maintain a high level of clinical suspicion of group A streptococcal infection when evaluating patients, especially those with a previous viral infection (including chickenpox) and those who are close contacts of patients with scarlet fever or group A streptococcal infection.
- Health care providers should also be remined to the increased risk of disease among household contacts of patients with scarlet fever and group A streptococcus. Close contacts of these cases should be managed according to national guidelines.
- Importance of hand hygiene, respiratory hygiene and adequate indoor ventilation must be further emphasized as important preventive measures in this winter season.
Risk Assessment:
- WHO currently assesses the risk posed by the reported increase in group A streptococcal infections to the general population in some European countries as low, considering their potential to be high to moderate.
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