Strep A key questions answered by experts including contact tracing, schools, parties, and more

Strep A key questions answered by experts including contact tracing, schools, parties, and more

The recent prevalence of Strep A infections in young people around the UK has caused understandable concern for parents. Schools and nurseries have shared information about hygiene and best practice while experts have been keen to highlight the key symptoms of invasive group A streptococcal infection (iGAS).

Though cases remain relatively rare in Wales – usually causing scarlet fever, a mild illness – there has been at least one confirmed outbreak while, tragically, seven-year-old Hanna Roap from Penarth died having fallen ill. Since September a total of 15 UK children have died after invasive Strep A infections.

We’ve put some of the key questions and concerns of children to experts at Public Health Wales to get all the latest information for parents and others concerned about whether they should be taking any additional precautions and the main things to look out for. You can find more detail in the online FAQs provided by Public Health Wales here.

Is it safe for schools to be open?


Should I be sending my child to things like Christmas parties, birthdays, and clubs as normal?


Are children with known immune issues at greater risk? Should I keep them at home?


Are places like schools and nurseries doing things like contact tracing in the way we saw during the pandemic? Do children who have been in contact with someone who’s been ill need to isolate?

Public Health Wales will organise any contact tracing required. If your child is ill we would advise that they do not attend school or nursery.

Are there ages where children are at greater risk? Do boys or girls have the same level of risk or is one more at risk than the other?

Children under 10 are at greater risk. There is no difference between girls and boys.

Is it happening because of lockdown and children haven’t been exposed to germs?

We are seeing an increase in cases of scarlet fever this year and it is presenting itself earlier than normal. This is likely to be as a result of children being more isolated during the coronavirus pandemic and now being back in social settings more frequently. Increases in cases of scarlet fever may result in more cases of the far rarer iGAS.

How common/rare is it?

In very rare cases group A streptococcal infection can cause iGAS, a rare complication which affects fewer than 20 children in Wales each year. Although iGAS is a worrying condition the majority of these children will recover with proper treatment.

Can I get a Strep A swab at a pharmacy?

Some pharmacies in some areas of Wales provide a ‘sore throat test and treat’ service. The service is intended for patients aged six years and over with symptoms of acute, uncomplicated sore throat – it’s not a ‘Strep A screening service’. Patients with any ‘red flag’ symptoms, such as a rash, persistent high temperature, or muffled voice will be referred to GP or A&E as appropriate.

People are saying it’s caused by the nasal flu spray. Is that a myth?

We advise people only seek advice from trusted sources of information. Getting the flu vaccine can protect children as it can reduce the chances of getting secondary infection such as Strep A, which can develop into more serious disease.

Are there any symptoms that are more concerning than others?

The symptoms of scarlet fever include a sore throat, headache, fever, nausea, and vomiting. This is followed by a fine red rash which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. Older children may not have the rash. On more darkly-pigmented skin the scarlet rash may be harder to spot but it should feel like sandpaper. The face can be flushed red but pale around the mouth.

Symptoms of iGAS are as follows:

  • Fever (a high temperature above 38°C)
  • Severe muscle aches
  • Localised muscle tenderness
  • Redness at the site of a wound

If my child is confirmed as having Strep A will they get seriously ill?

While we understand that parents are likely to be worried by reports they are seeing related to iGAS cases of invasive group A streptococcal infection (iGAS) remain rare in Wales and children have a very low risk of contracting the disease. In most cases infection with streptococcal A bacteria causes scarlet fever, usually a mild illness.

Cold and flu-like symptoms are very common at this time of year, especially in children. Most children with these symptoms will have a common seasonal virus, which can be treated by keeping the child hydrated, and with paracetamol. Some children with cold and flu-like symptoms – sore throat, headache, fever – may be experiencing some of the early symptoms of scarlet fever, which also circulates at this time of year. These children will go on to develop scarlet fever-specific symptoms including a fine pink-red rash that feels like sandpaper to touch and parents should contact their GP if they see these symptoms. While scarlet fever is more concerning than a common cold it is still usually a mild illness from which most children will recover without complications – especially if the condition is properly treated with antibiotics.

Are there plans for pharmacies to open 24 hours a day? If my child gets sick during the night I’m worried about how long I’ll need to wait to get antibiotics.

We can’t comment on plans for pharmacies. If you have concerns about your child’s health out of hours then please call NHS 111.

I’ve heard children might be given preventative antibiotics. Do they need this and if so how do I get them for my children?

We continue to follow our usual guidance for the management of cases and contacts of iGAS and are not currently advising mass prescription of preventative antibiotics for school children in Wales. All cases are assessed by Public Health Wales and any contacts requiring antibiotics will be proactively contacted and given information on how to get them.

What should I do if my child shows symptoms?

Parents who suspect their child has symptoms of scarlet fever are advised that they should:

  • See their GP or contact NHS 111 as soon as possible;
  • Make sure their child takes the full course of any antibiotics prescribed by the doctor;
  • Keep their child at home, away from nursery, school, or work and follow any guidance provided by their GP on how long they should remain absent from these settings.

Parents are being advised to contact their GP or get medical advice straight away if they think their child has any of the signs and symptoms of iGAS disease.


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