In the UK nine children died from streptococcus A infections, in France these infections are also increasing unusually and have already caused three deaths, including two children. Concerned health authorities are asking health professionals to be vigilant.

Nine dead in Britain and three in France. In just a few weeks, the number of streptococcal A infections in France and in our British neighbors increased in an unusual way. Streptococci A, a category of bacteria that specifically causes scarlet fever, can cause mostly mild infections. However, they can be fatal in children or people at risk.

With this increase in cases, health authorities are concerned and are asking health professionals to be vigilant.

• What is the situation in France and Great Britain?

Concerns have started to spread across the English Channel, where at least nine children have died in just a few weeks as a result of invasive Strep A infections. The British authorities called for vigilance. For comparison, during the last Strep A infection season between 2017 and 2018, four deaths of children under the age of 10 were recorded in England.

The cases are also increasing in France. In a message addressed to health professionals this Tuesday, the Directorate-General for Health (DGS) reports a “larger number than usual” of cases in different regions (Occitanie, Auvergne-Rhône-Alpes, New Aquitaine) in the last two weeks .

So far, “at least 8 children with no identified risk factors” have been hospitalized in intensive care, of whom “two have died.” Three cases have been identified in adults, and one of the affected patients has died.

• What do the health authorities say?

However, the situation is probably not limited to these proven cases alone. Indeed, the DGS reports a “recurrence of severe forms and deaths (laryngitis/pleuropneumopathy, sudden unexplained cardiovascular arrests indicative of streptococcal toxic shock) following streptococcal A infection in several children for a few weeks” .

According to health officials, the recent severe cases are “unrelated” and appear to be caused by “different strains”.

The DGS, which states that “investigations” are ongoing, meanwhile calls on the nurses to be “vigilant”. Healthcare professionals are therefore encouraged to carry out diagnostic tests for angina and scarlet fever and to remind their patients of “the importance of barrier measures this winter season”. All cases of severe Strep A infection must also be reported to the ARS (Regional Health Agencies).

• What are the symptoms that should alert you?

Streptococci A can cause either mild or fatal infections, especially if they enter the bloodstream. They are the cause of diseases such as angina pectoris, impetigo (skin infection) and scarlet fever. As the Pasteur Institute points outInfections with streptococcus A “are common”, as do infections with streptococcus B. These two bacteria only cause symptoms “under certain conditions” or “in people at risk”.

Group A streptococci are only transmitted “from man to man” by droplet infection (sneezing, coughing). In “invasive” or severe infections, Streptococcus A can be responsible for necrotizing skin infections, pleuropneumopathies, demeningitis, which can be associated with streptococcal toxic shock syndrome.

“Symptoms of non-invasive group A streptococcal infection include: fever, sore throat, and mild skin infections such as rashes, ulcers, bumps, and blisters,” details public health authority Canadian.

• Can the lack of amoxicillin have consequences?

This multiplication of cases of Strep A infection comes in a tense context: the shortage of amoxicillin, the main antibiotic in children. Several medical associations — infectious diseases specialists and paediatricians — have already warned that this shortage could lead to a serious public health crisis in children.

However, unlike childhood diseases of viral origin, such as bronchiolitis, which are currently in the midst of an epidemic, Strep A infections can be treated with antibiotics such as amoxicillin or penicillin.

In this context, the DGS has planned to “clarify the recommendations for the management of cases and contacts, especially in the current context of tensions around amoxicillin”.