Is Strep throat infection on the rise?
Everyone is familiar with Strep throat.
It is the type of infection that we, as pediatricians, see every day at the clinic and it is a very common reason for prescribing antibiotics.
We have a mythological chapter on this website about throat infections caused by Streptococcus which you can be find it in the link here. In the meantime, however, the media has been portraying a very frightening image about the spread of Streptococcus infection in the United Kingdom.
Since the primary goal of this website is to provide parents with the most accurate and reliable information, at an equal level, this is a great opportunity to use this platform to explain to parents what it is happening out there, what they should and shouldn’t be concerned about and what isn’t so important.
What will I not be covering in this chapter? I won’t be discussing group A streptococcus infection in detail, its presentation and treatment. You can find that information here.
I will be covering the current epidemic in England and what is happening in the rest of the world and how it should be handled. Stuff that all parents should be familiar with.
What is going on in the UK?
In the past few weeks there have been reports from the UK about a surge in the prevalence of group A streptococcus infections. Both in children and in adults – all the way from a simple throat infection to Scarlet Fever (read more here) and invasive infections (mostly bloodstream infections), that were caused by the pathogen.
What is the reason behind this surge?
It seems like it is related to the winter season.
Every winter pediatricians observe an increase in the number of throat infections caused by Strep. This could be related to the fact that upper respiratory tract viral infections are more common in winter and are often followed by a strep infection.
What should we be aware of when following the reports from the UK?
The UK has been carefully reporting a surge in the number of strep throat and scarlet fever cases. This spread has been occurring in certain areas of England. So far, it this makes sense. The increased prevalence has been compared to previous years, including the years before the COVID-19 pandemic.
What should be noted are the reports regarding invasive streptococcal infections in all ages, but specifically in children. According to reports from the UK, cases of invasive streptococcal infections have been on the rise across all ages, and not only in children.
Are these cases of strep throat complications that we’re talking about? Not necessarily.
Is it happening in children with chicken pox (in the UK, the chicken pox vaccine is not part of the routine childhood vaccination schedule and invasive strep infections tend to occur secondary to chicken pox infections, read more about this here)? It doesn’t say.
There is more information that needs to be revealed for us to be able to understand the full picture.
So, does this mean the UK is experiencing an epidemic?
There has definitely been a rise in the number of cases in the UK. It is something that the ministries of health in England need to investigate and it is something that needs to be discussed and understood.
What about the rest of the world?
In the meantime, nothing is really happening in the rest of the world. Is there somewhat of an increase in the number of cases of strep throat when compared to previous winters? I’m not sure. Moreover, the World Health Organization (WHO) has assessed that the risk for the general population posed by invasive Group A streptococcus infections remains low.
How should parents handle the situation?
Parents should go on as usual. See a pediatrician if your child has fever and throat pain.
If the physician notices characteristic signs in a child of the right age, he/she should take a throat swab and decide on treatment according to our guidelines. Note that taking a throat swab every single time a patient presents with throat pain is completely wrong.
Managing a case of strep throat or ruling out strep throat is the bread and butter of pediatrics, but especially because it is such a common infection and parents are very much involved in the decision making, sometimes, wrong decisions are made.
I recommend everyone to read and memorize the 10 rules below about diagnosing and managing strep throat properly in children. And for now, don’t get hysterical about what the media has been reporting.
What are the 10 rules about proper diagnosis and management of strep throat in children?
– Most pediatric throat infections are caused by viruses.
– Throat infections caused by streptococcus bacteria are uncommon in children under the age of three years.
– Strep carrier rates in the general population may be as high as 15%, and so, one should not test healthy children or children presenting with viral symptoms (absence of fever or the presence of cough and runny nose), for strep throat.
– Due to the fact that clinical diagnoses are difficult to make, when strep throat is suspected one should confirm the diagnosis by taking a swab (either a rapid-test or culture).
– The throat swab should be taken in the correct manner. When strep throat is strongly suspected in children and the rapid test is negative, a culture should be taken.
– The treatment of choice in children/adults that are not allergic to penicillin is penicillin for 10 days.
– There is no need for a repeat throat swab at the end of the course of treatment.
– Detection and treatment of carriers should be avoided.
– If the infection recurs, diagnosis and treatment should be repeated as in the previous infection. A full course of treatment (10 days) should be repeated.
– In cases of recurrent infection, refer to a specialist to confirm whether it is a case of recurrent streptococcal infections or a different condition (such as PFAPA).
Good luck, Dr Efi.
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