While we talk endlessly about Strep A sore throat we might be missing the bigger picture. Strep A is a bacteria that is responsible for more than a sore throat.
Scarlet fever, which is a reportable strep A infection, changed dramatically in 2013 where it moved from a maximum of 200 reported cases a week to over 1,000 cases a week in March of 2014. Annual incidence rose from 2,000 to over 5,000 in a single year. The peak has continued to grow to over 1,500 last year and occurring slightly earlier in March, but with a second peak of 600 cases well into May. The recommendation is still to treat with penicillin and isolate until 24 hours after the antibiotic to reduce spread. The highest rates are seem in the East Midlands, North West, Yorkshire and Humber and the West Midlands.
If you want to know a little more about Scarlet Fever look here https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/338368/Scarlet_fever_Q_and_A_factsheet.pdf
Invasive Group A Step infections are serious with a mortality of around 16% and conditions such as necrotising fasciitis can cause very high healthcare costs and lead to considerable disability. It is the condition that the newspapers love to call the ‘flesh-eating bug’. Last year was a bad year with over 80 cases reported in a single month. This year we are tracking in a similar pathway. It is interesting to note that the risk to close contacts of someone with invasive strep A and death is often quoted as similar to meningococcal disease.
By now you are beginning to understand that strep A sore throat is an important minor infection that is associated with both Scarlet Fever which affects mostly the young and invasive Strep A infections that affect mainly older people. Get the recent public health report and look at how the reportable diseases track every year. We are just about to hit the peak season.
But there is some good news in this story. We now have a rapid antigen test that can provide a diagnosis of Group A strep in the throat within 10 minutes (OSOM from Sekisui). And resistance to penicillin is still unheard of. Following an accurate diagnosis and initiation of penicillin your patient is not infective at 24 hours, where without treatment they may be infective for two weeks or more.
So why don’t we accurately diagnose strep A infection when it is in the throat, treat quickly with an antibiotic which is 100% effective and reduce the spread of strep A. Perhaps it will curb the rise in Scarlet Fever and invasive Strep A infections – only time will tell.