Strep A (GAS)

GAS is spread by close contact with an infected person and can be passed on through coughs and sneezes or from a wound.

They can also be transmitted environmentally through contact with contaminated objects, like towels and bedding, or eating contaminated food.

Some people can have the bacteria present in their body without feeling unwell or showing any symptoms of infections and while they can pass it on, the risk of spread is much greater when a person is unwell.

GAS causes infections in the skin, soft tissue, and respiratory tract. It’s responsible for infections such as tonsillitis, pharyngitis, scarlet fever, impetigo and cellulitis among others.

Sometimes, GAS can cause Scarlet Fever.

Symptoms include a sore throat, headache, and fever, along with a fine, red or pinkish body rash with tiny, rough pimples (“sandpapery” feel). On darker skin the rash can be more difficult to see but the skin will have a sandpapery feel. They might have a very red tongue or lips. Contact NHS 111 or your GP if you are worried your child has Scarlet Fever, because early treatment of Scarlet Fever with antibiotics is important to reduce the risk of complications such as pneumonia or a bloodstream infection. If your child is not too sick, these antibiotics can safely be given by you at home. If your child has Scarlet Fever, keep them at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.

Most children with GAS throat infection or Scarlet Fever will get better with antibiotics. Unfortunately, very occasionally some children become unwell later because their body produces an exaggerated immune response, or the bacteria gets into the blood stream and causes a more severe infection (called “invasive GAS” or iGAS).

iGAS Infections

The same bacteria which cause scarlet fever can also cause a range of other types of infection such as skin infections (impetigo) and sore throat.

In very rare cases, the bacteria can get into the bloodstream and cause an illness called invasive group A strep (iGAS). Whilst still very uncommon, there has been an increase in iGAS cases this year, particularly in children under 10 years old. It is very rare for children with scarlet fever to develop iGAS infection.

iGAS infections are most common in the elderly, the very young, or people with an underlying risk factor such as injecting drug use, alcoholism, immunosuppression, or cancer.

It’s always concerning when a child is unwell. GAS infections cause various symptoms such as sore throat, fever, chills, and muscle aches.

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.

Contact NHS 111 if or your GP if:

• your child is getting worse
• your child is feeding or eating much less than normal, especially if they are drooling or appear in pain when swallowing
• your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
• feeling thirsty
• dark yellow, strong-smelling pee
• peeing less often than usual
• feeling dizzy or lightheaded
• feeling tired
• a dry mouth, lips, and tongue
• sunken eyes (dark circles under eyes)
• crying without tears
• your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
• your baby feels hotter than usual when you touch their back or chest, or feels sweaty
• your child is drowsy (much more sleepy than normal) or irritable (unable to settle them with cuddles, toys, TV, or snacks – especially if they remain drowsy or irritable despite any fever coming down)

Call 999 or go to A&E if:

• your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• there are long pauses (more than 10 seconds) when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake
• your child feels very cold or clammy to touch
• your child has severe pains in their arms, legs neck or back
• your child has a painful, red area of skin, especially if it is getting bigger quickly

High Temperature guidance:

• Parents can see guidance on when to seek advice if your child has a high temperature, by using the free HANDi Paediatric app (developed by the NHS in Devon). Answer the quick questions in ‘High Temperature’ section for clear simple guidance.
• The app is also very useful for other common childhood conditions

GAS usually responds well to common antibiotics such as Penicillin and Amoxicillin.

Due to supply issues in some areas, you may need to give your child crushed tablets rather than medicine.

Please see the information sheets below and video for an explanation of how to give your child tablet treatment:

• How to swallow tablets
• Helping your child to swallow tablets

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 and warm water 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.

You can help stop the spread of infection through frequent hand washing and by not

sharing eating utensils, clothes, bedding, and towels.

Children and adults with suspected scarlet fever should stay off nursery / school / work until 24 hours after the start of appropriate antibiotic treatment.

Anyone with suspected or confirmed scarlet fever should stay away from vulnerable adults and children.

We know that when there are lots of viruses circulating, like flu, more serious infections like GAS can use this to get a hold. Reducing these viruses through vaccination, including Flu and Covid vaccines, can protect against GAS outbreaks. Getting yourself and your child vaccinated is the best way to make sure they are protected from serious illnesses.