Cases of Strep A, Scarlet Fever on the Rise Among Children: WHO

Health authorities are closely monitoring the emerging trend

A girl and her mother sit in the waiting room of a private pediatrician in Vincennes, near Paris, on Dec. 2, 2022. (BERTRAND GUAY/AFP via Getty Images)

Group A streptococcus (GAS) infections have been spreading in Europe recently, with the United Kingdom, France, Ireland, the Netherlands, and Sweden reporting a significant spike in cases in children under 10 years of age since September. Pediatric hospitals in the United States have also reported a rise in such cases from previous years.

On Dec. 12, the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) jointly issued a warning about emerging trends regarding the disease.

GAS or Strep A infections can incur sore throat, headache, fever, and other mild sicknesses, and can also morph into a severe invasive GAS (iGAS) infection, such as scarlet fever, necrotizing fasciitis, and streptococcal toxic shock syndrome.

Analysis by WHO and ECDC suggested that the increase in children iGAS cases may be related to the recent increase in transmission of respiratory viruses, including seasonal influenza and respiratory syncytial virus (RSV).

“[C]oinfection of viruses with Group A Streptococcus may increase the risk of invasive disease (iGAS),” it said.

The surge in cases in France and the UK is several times higher than before the outbreak of COVID-19. At least 16 children have died from iGAS infections in the UK. An increasing trend has also been reported in Ireland, the Netherlands, Spain, and Sweden, The Daily Mail reported on Dec. 13.

Hong Kong’s health authorities also said on Dec. 18 that scarlet fever cases have been increasing in the Asian city the past few weeks.

Last week, the U.S. Centres for Disease Control and Prevention said they are concerned about a possible spike in iGAS infections in children in the country.

Pediatric hospitals in Arizona, Colorado, Texas, and Washington told NBC News that an above-average number of iGAS infections have been found this quarter compared to previous years.

Meanwhile, two preschoolers in Colorado have died of iGAS infections, according to CPR News 14.

Dr. James Versalovic, chief pathologist at Texas pediatric hospital in Houston, the largest pediatric hospital in the United States, said that potential iGAS infections have more than quadrupled in the past two months compared to the same period last year.

The Texas pediatric hospital recorded about 60 cases in October and November, he said.

According to the CDC, millions of non-invasive GAS infections are recorded in the United States each year, but iGAS is rare, with about 14,000 to 25,000 cases per year. Death tolls of iGAS infections range from 1,500 to 2,300 per year.

iGAS Infection Causes Scarlet Fever

A pediatrician feels the tonsils in a child with a sore throat and shows his tongue. (Shutterstock)

Regarding iGAS-induced scarlet fever cases in the UK, an article published by British-based National World on Dec. 14 said that the outbreak of iGAS in 12 areas of England and Wales has led to an ongoing spike in scarlet fever cases.

The report, citing official data, said there were 1,702 cases of the highly contagious infection reported to health authorities last week—a 26 percent rise from the week before.

In a Dec. 15 update to the UK government website on scarlet fever and iGAS, Colin Brown, deputy director of the UK Health Security Agency, said that scarlet fever and streptococcal laryngitis are common childhood illnesses that can be treated with antibiotics. He told worried parents that is uncommon for bacteria to enter the bloodstream and cause the more serious iGAS.

“I want to stress that while we are seeing an increase in cases in children, this remains very uncommon,” he said. “There are lots of winter bugs circulating that can make your child feel unwell, that mostly aren’t cause for alarm.

“Make sure you speak to a healthcare professional if your child is getting worse after a bout of scarlet fever, a sore throat, or respiratory infection—look out for signs such as a fever that won’t go down, dehydration, extreme tiredness, intense muscle pains, difficulty breathing or breathing very fast.”

Scarlet fever occurs in children aged 5-15 years and its main symptoms are fever, sore throat, a white coating on the tip of a red, swollen tongue with small bumps (referred to as Strawberry tongue), skin rashes within 12 to 48 hours on infection, and minor toxicity symptoms such as headache, nausea, vomiting, abdominal pain, loss of appetite, and other discomfort.