Increase in Group A Streptococcus Cases

Infections caused by Group A streptococcus (GAS) have been increasing in Scotland since the beginning of October.

A common presentation of GAS is scarlet fever which causes the following symptoms: headache, sore throat, high temperature and raised pink/purple spots that join up to produce a skin rash, which feels like sandpaper to the touch.

Group A strep is confirmed in the laboratory from a throat swab. In Scotland, Public Health Scotland (PHS) reports the number of positive throat swabs for GAS as an indicator proxy measure of scarlet fever. (Scarlet fever has not been a Statutory Notifiable infection in Scotland since 2008 so there are no Official Statistics on this infection. PHS do however monitor and report laboratory confirmed cases of upper respiratory infections with Group A strep as an indicator of scarlet fever.)

Cases of GAS usually increase during the winter and the last time significant numbers of cases were reported was in the 2017/18 season. Peaks can occur every three to four years but social distancing measures implemented during the COVID-19 pandemic may have interrupted this cycle and explain the current increase being observed.

Whilst GAS infections, including scarlet fever, are common; the more serious Invasive Group A Streptococcal (IGAS) infections are rare.

Since the beginning of October 2022, PHS has received reports of eight IGAS cases in children under 10 years. There have been no reported deaths in this age group in Scotland this season.

PHS is working closely with NHS Boards, as well as public health colleagues across the UK, and is monitoring the situation in Scotland.

Dr Jim McMenamin, Head of Health Protection (Infection Services) at PHS, said:

“While we are seeing increased incidence of Group A strep infections at this time, complications are rare.

“We would encourage parents and care-givers to ensure children practice good hand and respiratory hygiene to help reduce the spread of common infections like this.

“If your child is showing signs of scarlet fever, please seek advice form a health professional as most cases respond promptly to early treatment with antibiotics.”

More information on scarlet fever, including when to seek medical advice, can be found on NHS Inform.

Scarlet fever is very contagious and can be caught by:

  • breathing in bacteria in airborne droplets from an infected person’s coughs and sneezes
  • touching the skin of a person with a streptococcal skin infection, such as impetigo
  • sharing contaminated towels, baths, clothes or bed linen

It can also be caught from carriers – people who have the bacteria in their throat or on their skin but don’t have any symptoms.

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