Scarlet fever is on the rise in the UK, with cases more than four times normal for this time of year. And a rare but serious invasive disease caused by the same bacteria that causes scarlet fever and strep throat – group A streptococci – is also on the rise, killing at least eight children in the UK, according to media reports.
The unusual increase is seen as another cycle of abnormal disease transmission reverberating in the wake of the COVID-19 pandemic. Like many other seasonal infections, scarlet fever cases in the UK all but flattened out at the end of the 2019-20 season and hit the bottom of the chart throughout the 2020-2021 season, according to data published by the UK Health Security Agency.
Now that most pandemic-related health restrictions have been lifted or at least relaxed, a slew of seasonal infections, especially those that hit children hardest, are back. Many returned with some ferocity, finding an even larger pool of susceptible victims than usual after a break. Many of these disease cycle abnormalities have been observed in seasonal viruses, namely enteroviruses, adenoviruses, influenza and RSV (respiratory syncytial virus (sin-SISH-uhl)), which are currently flooding hospitals and pediatric services in the United States.
“Many infections have become rarer during the restrictions of the recent pandemic and are now returning rapidly as the mix normalizes,” said Adam Finn, professor of pediatrics at the University of Bristol, in a statement. “[Group A strep] is no exception, and we have seen an increasing number of cases in recent months. »
The transmission of group A streptococcal bacteria is associated with the transmission of viruses. Historically, group A streptococcal infections have been closely linked to the spread of chickenpox, although clinicians note that streptococcal infection can occur after other viral infections. It is unclear exactly what the link is between certain viral infections and group A streptococcus. The researchers hypothesized that a confluence of factors could explain the link, from the overlapping time in the cycle of disease, similar routes of transmission (eg, respiratory), and common age of victims.
It’s also possible that some germs share common methods of suppressing the immune system to trigger an infection. Thus, infection by one germ could pave the way for another that follows a similar path. There is evidence of this with chicken pox and group A strep, which similarly alter the activity of some T cells. But some viral infections also suppress the immune system more generally. Perhaps the best example is measles, which suppresses the immune response for weeks or months after an infection, leading to what some experts call “immune amnesia.” Before childhood vaccination campaigns, the spread of measles was closely associated with increases in cases of whooping cough (whooping cough), caused by the bacteria Whooping cough Bordetella.
The current increase in group A strep infections in the UK is not clearly linked to an increase in varicella cases. Chickenpox is not a notifiable disease in the UK, meaning official counts are not available. However, sentinel surveillance data suggests there has been no unusual increase.
The rise of Streptococcus A, however, coincides with viral respiratory infections.
“Usually we see a lot of [group A strep] cases in late spring or early summer, often after varicella infections,” Elizabeth Whittaker, an expert in pediatric infectious diseases and immunology at Imperial College London, said in a statement. “The high numbers at this time of year are unusual and likely occurring as normal seasonality has not yet returned… We are seeing more pneumonia than usual, most likely as group A strep infections coincide with the peak of winter respiratory viruses that are typical at this time of year.”
Group A strep infections usually cause mild infections such as strep throat, scarlet fever, and impetigo, a skin infection, which are effectively treated with antibiotics. In the UK, there were 851 cases of scarlet fever in week 46 of this year (ending November 19), while the average for previous years was 186 cases in week 46, reported the UKHSA. The tip is part of a larger climb; there have been 4,622 scarlet fever notifications in weeks 37-46 this year in England, compared to an average of 1,294 in the same period over the previous five seasons.
In rare cases, group A strep can enter the bloodstream, causing a serious, invasive disease called invasive group A strep (iGAS), which can be fatal in young children. So far this year, the UKHSA has recorded 2.3 cases per 100,000 children aged 1 to 4, compared to an average of 0.5 during pre-pandemic seasons (2017 to 2019) and 1.1 cases per 100,000 children aged 5-9 years compared to the pre-pandemic period. pandemic average of 0.3 at the same time of year.
Severe cases remain rare, but identifying strep A infections may be more difficult than normal this year as it circulates among respiratory viruses, potentially delaying treatment.
“Severe invasive strep A is rare, and parents need not worry but know when and how to seek medical attention,” Whittaker said. “We normally expect fevers due to viral infections to settle within 4 or 5 days, so if they persist or are associated with lethargy, difficulty breathing, poor alcohol consumption or wet diapers / urine, families should contact NHS111 for advice,” referring to a non-emergency medical service line in the UK.
“Prompt treatment with antibiotics can manage these infections, but it’s important that they are recognized and treated quickly,” said Nathalie MacDermott, an expert in pediatric infectious diseases at King’s College London. “Prompt treatment of scarlet fever and strep throat also reduces the risk of a child developing invasive group A strep and reduces the risk of spreading the infection to other children at school or to members. of the family. “
In the US, scarlet fever is not a reportable disease – so there are no official numbers – but there is surveillance for iGAS cases. During a press briefing earlier this week, Barbara Mahon, an epidemiologist at the Centers for Disease Control and Prevention, said: “As far as I know, we have not heard of any notable increase [in iGAS cases].”
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