Speaker 1 00:00:04 Hello and welcome to the Wonder Baba podcast. My name is Sheena Mitchell, I'm a pharmacist and mom of three. I'm here to chat all about child and family health. I just wanted to jump on to do a quick episode on Group A Strep and Scarlet Fever. Obviously it's something that's on all of our minds at the moment because of the very sad passing of a little four year old girl in the Republic of Ireland last week. So I just thought it was a good time to pop a little episode up explaining what's going on and what we need to look out for and just, yeah, make it a bit easier to understand. So you hear a lot of talk of group A strep and group A strep cock eye are basically a group of bacteria that can cause different kinds of infections. Now they're actually kind of lying dormant and up to 20% of people's skin or throats without causing any disease or them being any way aware.
Speaker 1 00:01:00 But sometimes it can cause sickness and this is a really normal thing. So pre covid, every year for the last forever gps have been diagnosing kids and adults with strep a infections. So the ones we're most aware of would be things like a sore throat or tonsillitis where you know this white patches on the throat and you get a bit of a fever with it and generally unwell. And sometimes that requires antibiotics. Sometimes people can just deal with it at home themselves. Also, things like impetigo, which is a common skin infection, which causes a red kind of bumpy rash and it's quite ugly really cuz it tends to po and get crusty around the child's mouth and also on their hands. So that's also something that's really normal. Another thing that always circulates as well is scarlet fever. So I suppose the reason why this has come up so much this year is that in Ireland we don't actually, you know, notify incidents of scarlet fever in Ireland, whereas in the UK they do.
Speaker 1 00:02:07 So in the uk, if a child is diagnosed with scarlet fever, then the authorities need to be notified. So they monitor the levels in the community. In the UK they have experienced a fourfold increase in scarlet fever cases. So we don't know what's happening here. Um, I've certainly heard of a few scarlet fever cases going around, but we can kind of assume really that the situation is similar. So in Ireland we do monitor the levels of invasive streptococci disease and at the moment as it stands, there's only been 56 cases so far this year in Ireland that is actually lower than pre pandemic levels when you know it would've varied anywhere between kind of 110, 140 per year. Granted during the covid years, the numbers were down in the thirties and forties, so it has increased a bit on the last two years, but not dramatically.
Speaker 1 00:03:03 And it's still not back up at pre pandemic levels. It's something that we should be aware of because of what's going on in the uk, but it's not something that we need to panic about. And that's really important because you know, once something starts getting talked about a lot in the media, it can become extremely worrying. And for parents, we've just come through and are actually still going through surges and high levels of osv, the respiratory sync TI virus, uh, which causes bronchiolitis. I have an episode on that as well. And there's also high levels of flu starting to circulate now. So as a parent, I think we kind of hoped this winter would be different. We've just come out of a horrible couple of years of infection prevention measures and sickness and covid and we're all tenses. And I think as soon as we hear doom and gloom is coming, obviously we're kicked up into such a heightened state of anxiety and that's normal.
Speaker 1 00:04:08 Obviously there's been several deaths in the UK and one in the Republic of Ireland and like it's your, it's any parents were a nightmare, deepest, deepest sympathies are extended to the families affected and yeah, it's horrendous. So look, there's nothing that we can do to make it less emotive because our children are lives, our children are, everything tools us. And so it's natural to worry. But I think while we worry, we have to keep perspective. And I think the best way to do that is to say that at the moment the figures circulating aren't much higher than other years. However, one death is one death too many. I think everyone will agree with me there. Okay, all I want to achieve today is to help people know what to look for. So if scarlet fevers on the rise will start with that. So Scarlet Fever is a strep bay infection.
Speaker 1 00:05:19 It causes a rash, a sore throat, a swollen tongue that can get red with little white spots on it, and it's often called strawberry tongue sometimes. Then it can go on to develop kind of a white covering and it can be still quite inflamed. And sometimes in medical terms that's referred to as beef tongue. Also, children will have a high temperature, so kind of over 38 degrees generally have a headache and possibly some nausea, vomiting, and a lack of appetite. So scarlet fever is quite a localized tongue and throat infection with then the typical silence of infection, which are a fever and just being off form with scarlet fever. The symptoms kind of generally come two to five days after exposure, but it can actually be up to a week. So if you've heard of a case in your child's crash or school, just do keep a close eye for seven days after exposure.
Speaker 1 00:06:20 The first symptoms that kind of start would be the throat and headache and the rash generally tends to start about 12 to 48 hours after that. So the rash is kind of a pink red rash, which generally starts as red blotches and it usually starts on your chest and back. It's actually caused by the toxins that are produced by the streptococcus. It tends to turn then kind of a pinky ready color and it gets quite bumpy and is described as feeling like sandpaper. It can sometimes go on then to look like sunburn and it will then after a few days start to peel. So that sometimes happens. So just to be aware that that is normal. After it kind of starts on the chest and stomach, it can te, it can spread to the ears, neck, elbows, inner thighs and groin. The rash generally, and this is where some confusion comes in, the rash generally doesn't affect the face, but the face gets flushed and that's where the name scarlet Fever comes from.
Speaker 1 00:07:27 So you'll see a child with reread cheeks, but they'll actually have a white area, pale area around their mouth and that's quite typical of scarlet fever for scarlet fever. Treatment wise, and this is important to know because I think this in the current climate where there are shortages of antibiotics, it's good to know that normally scarlet fever will resolve by itself. It usually takes a bit a week. Sometimes obviously children can get very sick and you know, in those cases, of course if they're showing any signs of dehydration or any signs of kind of lethargy or drowsiness or dizziness, of course you're going to go and see the doctor. But if you're at home and you're happy to keep your child home for one to two weeks, then it usually will clear up by itself. Home treatments would be just keeping plenty of fluids, soft foods if their throat is sore, giving calpol if needed, or any paracetamol product if the fever is high.
Speaker 1 00:08:26 And then the rash can sometimes be itchy. So a little bit of calamine or antihistamine might be no harm depending on their age other than treating at home. If you go to the gp, they may recommend antibiotics. I, I know the HSC are saying to people, and I completely agree that antibiotics due to antimicrobial resistance should only be used when they're absolutely necessary. Okay, so I agree with that. I also though as a parent and mom and as a pharmacist, want to say that antibiotics do reduce the length of the time that your child is infectious. So this is important. If your child does not receive antibiotics, you do need to keep them home for a week or two after your they're, your symptoms start. If they're on antibiotics and they're feeling well, they can actually return to school or crash 24 hours after their first dose of antibiotic treatment.
Speaker 1 00:09:22 Basically with antibiotics speeds up their recovery and you know, usually they'll be feeling better in four or five days if they've been feeling quite unwell. It also helps to reduce the risk of complications. As I said, most cases of scarlet fever will be mild and won't have any complications. So I suppose what I'm trying to say is it's really important not to panic if your child has a mild or moderate dose of scarlet fever. Your child may well not need antibiotics and you don't need to be stressing about the shortage as much maybe as is being presented. So if the antibiotics are recommended, it's generally a 10 day course of a penicillin based antibiotic and cause of a very disrupted supply chain at the moment, you may be given a second line option instead. So there are second line options like erythromycin. So really important that the course of antibiotics is finished.
Speaker 1 00:10:19 If you don't finish the course of prescribed antibiotics, there is a risk of developing resistance and that means when you need an antibiotic, again, it won't work. So really important to finish your course. Other than that, then obviously in terms of complications, and this is where we'll go on to talk about invasive disease, but the first thing to note is that there's a small risk of infections from just the bacteria spreading to other areas. I'm not talking about what they call invasive group a strap at the moment. I'm just saying that it can move to areas like the ear or throat. You can get an ear infection or a throat, ab abcess or sinusitis. So infections in your sinuses and pneumonia, their symptoms to watch out for if your child is suffering from scarlet fever at the moment. And obviously you should see a doctor because at that stage they may well need an antibiotic.
Speaker 1 00:11:10 And now what's been covered a lot in the media is something called invasive group-based rep. And with that really, really important to know the symptoms, but also to know that it is extremely rare. There is one study, it was published in the Emergency Infections Disease publication in March, 2019 that showed out of a sample of hundred 19,000 people from 2011 to 2016 in the UK that there was a 12 fold increase in the risk of invasive group, a strep after infection with scarlet fever within 60 days. So yeah, it's frightening, but it is still rare and we need to kind of not lose our heads and be too worried. Looking out for symptoms is the most important thing. So what are the symptoms of invasive group-based strep? Well, a fever which you know, they may already have due to their normal strep infection, severe muscle aches, so really bad muscle pains.
Speaker 1 00:12:13 Your child might get dizzy, they may become confused, they may have stomach pain, they may be vomiting and nausea and really just be very, very sick. Obviously if your child has any of those symptoms, you're going straight to the gp. There is no vaccine at the moment for streptococcal infections, but you can help prevent the spread of the infections by keeping your child home if they're sick, if they started antibiotics, obviously they can return if they're feeling well 24 hours after the first dose. But other than that, everyone should be doing a lot of hand hygiene right now. Your kids shouldn't be sharing glasses or utensils or even tiles or clothing, especially if they even have something like an impetigo infection. So not just scarlet fever. So it's just really to be aware of the symptoms so that you can respond to them. I hope that's been helpful.
Speaker 1 00:13:04 It kind of gives you an understanding of what the symptoms are of Scarlet Fever and what the symptoms are of an invasive group, a strep, and what the treatment would be for all of them. So obviously if you have any questions at all, you can hop onto my Instagram at Wonder Baba Care and I will try and answer them for you. And if you could follow my podcast, it would be absolutely brilliant, so you can find it wherever you get your podcasts. Just by searching a Wonder Baba podcast. You can check out articles on all these
[email protected]. And yeah, look, I hope everyone has a really healthy winter, and try not to wear the stress of parenting too heavily because our children do pick up on that. So day by day, try and find little moments just to smile and keep this time of year magical time for everyone. Okay, thank you all so much for listening. Bye.
