An unexpected increase in cases of streptococcal A (strep A) infection in the United Kingdom is troubling for families, healthcare practitioners, and researchers. Although strep A infections typically peak sometime in the spring and summer, the case counts continued to climb through the fall of 2022. The abnormal surge resulted in the deaths of 13 children under the age of 15, alarming researchers. “To my knowledge, we’ve never seen a peak like this at this time of year, at least not for decades,” Shiranee Sriskandan, a microbiologist at the Imperial College London, reported to Nature.
What is Streptococcal A?
A strep A infection commonly presents as a sore throat and a skin infection, resulting in a condition known as scarlet fever. Children most often experience symptoms including high fevers, sore throats, and the eponymous red rash on the skin. Most cases are treatable with antibiotics. Occasionally, the disease can progress to dangerous levels in children with weaker immune systems, resulting in a condition known as invasive group A strep (iGAS) infection. These infections can have more catastrophic results, often leading to meningitis, toxic shock syndrome, and a “flesh-eating” condition called necrotizing fasciitis.
In this blog, we explore the recent outbreak of strep A in the United Kingdom and its possible relation to policies created during the COVID-19 pandemic.
A Surge in Scarlet Fever Patients
Researchers noted more than triple the number of usual cases of scarlet fever in England this past fall, with the surge extending past the expected drop-off period. In addition, case counts also remained higher than normal in the Netherlands.
High case counts of scarlet fever are not completely unheard of in the UK, however. Two years prior to the COVID-19 pandemic, an “almighty surge” of scarlet fever cases occurred in the UK, according to Sriskandan. These surges often result in resistant and sometimes more dangerous strains of the disease
becoming dominant. One such surge, in 2016, created the more invasive and harmful dominant strep A strain, resulting in more cases of serious illness.
The Pandemic as a Possible Explanation
A theory currently being explored by Claire Turner, a molecular microbiologist from Sheffield University, is that the COVID-19 pandemic may be to blame for the strange, continual increase in scarlet fever cases. All of us, no matter our occupation or location, have felt COVID-19’s effects on our social spheres since the pandemic was first declared. The most prominent restriction being, arguably, social distancing. According to the policy, schools were actively encouraged to keep students out of classrooms to avoid the spread of COVID-19. Though necessary, the precaution may have incidentally caused students to lose their normal opportunities to develop immunity to strep A, resulting in higher-than-expected numbers of off-season cases. The researchers also cite this lowered immunity among the causes of increased cases of other infectious diseases, such as influenza and chickenpox.
What the Future May Hold
As research into the causes of the outbreak continues, specialists advise caution and are trying to increase awareness of the disease’s spread, despite understandable weariness as a result of the COVID-19 pandemic. Researchers hope that, if social distancing is truly the cause of the elevated case counts, increased exposure among children will allow us to return to more typical seasonal outbreaks of scarlet fever and strep throat.
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