Scarlet fever and strep the health authorities are once again worrying, both nationally and internationally.
The European Center for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe have reported an increase in cases, following a period of low incidence of group A strep infections observed during the pandemic of COVID-19, but with an increase that had already occurred at the end of 2022.
Speak about Scarlet fever and strep is talking about the same thing: scarlet fever is in fact an acute infectious disease, contagious, due to a infection with group A beta-hemolytic streptococcal bacteria.
In particular, the ECDC talks about the case of Ireland where 101 cases were notified between the beginning of January and 4 March, compared to seven recorded in the same period in 2022. As a precaution, the Ministry of Health has also issued a circular signed by the director general of Prevention Gianni Rezza because «it is being registered an increase in cases of scarlet fever starting from January 2023, especially in children under 15 years of age. Confirmation of the increase in cases of scarlet fever also comes from the Italian Society of Pediatrics, but fortunately not of invasive infections.
According to the ministry document «the observed increase may reflect an early start of the season of GAS infections (this is how invasive group A streptococcal disease is defined, ed), together with increased circulation of respiratory viruses and possible viral co-infections which may increase the risk of invasive GAS disease. This is aided by increased population movements following a period of reduced GAS circulation during the COVID-19 pandemic.
Risk assessment
WHO and ECDC currently estimate the risk of iGAS as low for the general population, considering that the current increase in iGAS cases reported in some European countries is moderate, that the reported cases are not caused by a new strain, and that the disease is easily treated with antibiotics. « This season, typing data suggests that the increase in iGAS cases is not related to a specific or new strain or to an increase in antibiotic resistance. ECDC invites countries experiencing an increase in cases to share data relating to emm typing, multilocus sequence typing (MLST) and/or whole genome sequencing (WGS). WHO encourages countries that have reported an increase in iGAS cases to ad implement surveillance activities. Furthermore, it suggests informing the general population and healthcare professionals in order to improve early recognition, reporting and timely initiation of treatment of GAS cases.”
The directions
The Directorate of Prevention makes a series of recommendations: «It is important that infections related to GAS, such as pharyngotonsillitis and scarlet feverbe identified and treated promptly with antibiotics to reduce the risk of potential complications, such as iGAS, and reduce subsequent transmission. General practitioners (GPs), pediatricians of free choice (PLS), hospital and community specialist physicians must clinically suspect a GAS infection when evaluating patients with compatible symptoms, in particular those who have presented a previous viral infection ( including chicken pox and seasonal flu) and close contacts of patients with scarlet fever or iGAS. In addition, special attention must be paid to Streptococcus A infections among long-term care residentsdue to the increased risk of disease and deaths among this vulnerable population.
What are iGAS infections
iGAS infections, it is clarified, «may initially present with non-specific symptoms (fever, general tiredness, loss of appetite) and children, in particular, may have rapid progression to severe disease. Therefore, parents/guardians should request a clinical evaluation if their child has symptoms of concern and is not improving clinically. In case of hospitalizationrespiratory protection measures must be implemented.
The preventive measures
Healthcare professionals should always follow standard precautions and perform a risk assessment to assess the need for additional precautionary measures. «Good hand hygiene and the elimination of possible promiscuous behaviour (e.g. sharing utensils, glasses and personal items, etc.) can help control the transmission of infection. Schools and other educational settings where GAS infections are reported should follow directions for cleaning and disinfecting toys and frequently touched surfaces.
The vaccinations
Considered that some respiratory infections, such as influenza e varicellacan increase the risk of developing iGAS, «it is appropriate evaluate the possible offer of the relative vaccination to cohabitants and close contacts in the case (including classmates and teachers), based on the epidemiological situation and the vaccination status of the subject.
In the case of iGAS – explains the circular – drug prophylaxis for cohabitants and close contacts is not routinely recommended; however targeted pharmacological prophylaxis may be considered for close contacts at risk due to age (≥ 65 years) or concomitant conditions (e.g. HIV infection, varicella or diabetes mellitus).’