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Patient information about Streptococcus A (Step A) infections

People with symptoms of Scarlet Fever cannot use the Sore Throat Test and Treat service, available in some Pharmacies across South Wales, as this is for management of bacterial tonsilitis or viral sore throat only. Anyone with signs of Scarlet Fever (sore throat, fever, rash, swollen tongue) should instead, contact their GP or NHS 111. Anyone asking for the Sore Throat Test and Treat Service in a pharmacy who as symptoms indicating possible Scarlet Fever will be referred on to their GP or NHS 111 by the pharmacist.

Group A Streptococcus (GAS) – also known as Streptococcus pyogenes – are bacteria commonly found on the skin or in the throat, where they can live without causing problems. Under some circumstances, however, these bacteria can cause disease. GAS bacteria can cause a wide variety of skin, soft tissue and respiratory tract infections ranging in severity from mild to life-threatening. 

Information on the wide variety of skin, soft tissue and respiratory tract infections caused by Strep A, ranging in severity from mild to life-threatening is available on the NHS 111 Wales website.

The best thing to do is to provide the care that you would usually provide for a child with cold and flu like symptoms, but to familiarise yourself with the symptoms of scarlet fever and iGAS as a precaution.

Symptoms of Scarlet Fever

A common presentation of infection with streptococcal A is scarlet fever, usually a mild illness.

The symptoms of scarlet fever include:

  • a sore throat
  • headache
  • fever
  • nausea and vomiting

This is followed by a fine red rash, which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. Older children may not have the rash. On more darkly pigmented skin, the scarlet rash may be harder to spot, but it should feel like 'sandpaper'.  The face can be flushed red but pale around the mouth.

If you suspect a child has symptoms of scarlet fever you are advised to:

  • Contact your GP, visit the NHS 111 Wales website, or call NHS 111 Wales 
  • Make sure the child takes the full course of any antibiotics prescribed by the doctor
  • Keep the child at home, away from nursery, school or work and follow any guidance provided by a GP on how long they should remain absent from these settings.
  • Find up-to-date information and advice on Strep A infections on the NHS 111 website.

In very rare cases, Strep A infection can cause iGAS, a rare complication which affects fewer than 20 children in Wales each year.  Although iGAS is a worrying condition, the majority of these children will recover with proper treatment. Contact a GP or call NHS 111 Wales to get medical advice if a child has any of the following symptoms of iGAS disease:

  • Fever (a high temperature above 38°C)
  • Severe muscle aches
  • Localised muscle tenderness
  • Redness at the site of a wound.

In addition, also contact a GP or call NHS 111 Wales if: 

  • the child is getting worse
  • the child is feeding or eating much less than normal
  • the child has had a dry nappy for 12 hours or more or shows other signs of dehydration
  • the 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
  • the baby feels hotter than usual when you touch their back or chest, or feels sweaty
  • the child is very tired or irritable

Call 999 or go to the Emergency Department if:

  • the child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
  • there are pauses when the child breathes
  • the child’s skin, tongue or lips are blue
  • the child is floppy and will not wake up or stay awake

How to help prevent childhood infections

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By 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, they will be able to reduce the risk of picking up or spreading infections.

It is also important that children from two years upwards are protected from seasonal flu and have the vaccine.

Sources: iGAS infection remains rare, say public health experts - Public Health WalesNHS 111 Wales - Health A-Z : Streptococcus A (Strep A).

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