UK considers precautionary antibiotics for children as Strep A cases rise


Ministers have raised the prospect of UK children being given antibiotics as a precaution if a classmate falls ill with a Strep A infection, as they seek to allay parents’ fears following nine deaths.

Group A Streptococcus is a bacteria that can cause strep throat and scarlet fever, as well as skin infections. In a small proportion of cases, bacteria can enter the bloodstream of infected children and cause sepsis or chest, bone or joint infections or abscesses.

In its most recent update, the UK Health Security Agency on Friday said there were 851 cases of scarlet fever reported in the week to November 20, compared with an average of 186 in recent years. The unexpected rise in cases has sparked concerns that children may have failed to build up immunity during the Covid-19 pandemic as they normally would have done.

Schools minister Nick Gibb on Tuesday told Sky News that the agency was “working closely with the schools involved and giving very specific advice to those schools, which may involve the use of penicillin”.

The UKHSA pointed to existing guidance that allows preventive antibiotics to be given in certain situations.

It said there was “no good evidence” of antibiotics’ effectiveness in routine outbreak control in schools and nurseries. But it added that prophylactic treatment “can be considered in exceptional circumstances . . . for example when there are reports of severe outcomes, or hospitalisations”.

Experts said infected children can deteriorate quickly and warned parents to look out for signs including a persistently high temperature, being irritable or difficult to rouse, difficulty breathing and a rash that does not fade when pressed on and is spreading.

Nathalie MacDermott, lecturer at King’s College London, said prompt treatment with antibiotics of scarlet fever and Strep throat could manage the infections and reduce the chances of a child developing the invasive form of the condition.

Prompt treatment could also lower the likelihood of the infection “spreading to other children at school or household members”, she said, in comments released on Monday.

Another government minister later on Tuesday pushed back at suggestions that there was a shortage of antibiotics. Speaking during health questions in the House of Commons, Labour MP Clive Efford said parents had “concerns about the availability” of the medicines.

In response, health minister Maria Caulfield said GPs and A&E departments were ready to deal with the outbreak, adding: “We have directors of public health proactively going into schools where there are cases.”

She said: “There is no shortage of antibiotics, we want to reassure people of that, and we are keeping an eye on that on a daily basis.”

Shiranee Sriskandan, professor of infectious diseases at Imperial College London, said on Monday there was “potentially” a link between lowered immunity owing to the pandemic and the current outbreak.

She said children normally caught scarlet fever “in their first year at school, if at all”, pointing out that rates of the disease had plummeted in 2020-21.

School-age children may not have built up immunity to Strep A, “and so we now have a much larger cohort of non-immune children where Strep A can circulate and cause infection”, said Sriskandan. This was coupled with an unexpected rise in infections “at the wrong time of the year, when winter viruses like [the respiratory condition] RSV are circulating”, she added.



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