Invasive group A strep (IGAS) & how to manage in schools & nurseries

There have recently been 8 deaths in children under the age of 12 in the UK linked to Invasive Group A Strep (IGAS). With the UK still recovering from the Covid 19 global pandemic, it is understandable that parents and school staff want to know what Invasive Group A Strep is and how to manage an IGAS case in school or nursery.

In this article, we share what IGAS is, how to identify it, what to do with a suspected IGAS case in school and how to track cases across your school setting.

What is Invasive Group A Strep? (in simple terms)

Group A Streptococcus (GAS) is a type of bacteria found in the mouth and throat of children (some adults too but much less commonly). The GAS bacteria cause infections such as scarlet fever, strep throat and skin infections (like impetigo). These are easily treatable and are commonly experienced with school-aged children. However, a small number of GAS infections can become invasive, infecting the bloodstream or lungs, and can become much more serious (and, in rare cases, fatal). 

What are the signs and symptoms of Invasive Group A Strep?

IGAS is bacterial, not viral, meaning viral symptoms like a runny nose are unlikely to be Group A Strep but possibly a common cold. The NHS recognise the symptoms of Invasive Group A Strep as: 

• A high and persistent fever
• Severe muscle aches
• Redness at the site of a wound
• Vomiting or diarrhoea

For scarlet fever, there is often a prickly rash that will be red on light-coloured skin and a bright red tongue; the rash is unlikely to disappear when pressure is applied. For people of colour, the rash can be more difficult to spot, the rash will be raised from the skin and have a sandpaper texture.

Monitor and track incidents of Invasive Group A Strep using Medical Tracker

Why are there more IGAS cases in the UK currently?

There are questions about why there are more Invasive Group A Strep cases (and, unfortunately, deaths) in the UK currently. There is not yet data to definitively explain the reasons for the increase in cases, but it is thought the increase is likely related to the higher amounts of circulating bacteria.

Dr Elizabeth Whittaker, Honorary Clinical Senior Lecturer, Imperial College London, explains that Group A Strep infections are more commonly found in late spring or in early summer, often after chickenpox has done its rounds. But due to the restrictions from Covid 19, the normal seasonality of immunity of Strep A-related illnesses is yet to return. The lack of immunity to Strep A infections paired with increased winter respiratory viral infections could increase the number of GAS cases seen in schools and nurseries.

What do I do with a suspected Invasive Group A Strep case in school?

GAS infections are spread through close contact- coughs, sneezes and from open wounds.  It is important to encourage good hygiene practices around your school and nursery (similar to covid hygiene measures). Washing hands regularly, the use of hand sanitisers can be considered, covering mouths and noses with a tissue when coughing or sneezing and disposing of the tissue correctly are all recommended for good hygiene practices.

Your school can track and monitor any Invasive Group A Strep cases through Medical Tracker, where the symptoms and signs are aligned with those identified by the NHS. Following the recommended length of time off school, return dates can be set on the Medical Tracker app to avoid the contagious period (24 hours after taking antibiotics as recommended by the UK Health Security Agency). By creating insight reports, you are able to see potential IGAS outbreaks with increased cases in specific year groups or cohorts, giving parents confidence that your school is monitoring the increase in UK cases closely.

When do I call 999 with suspected Invasive Group A Strep?

Linked to the signs and symptoms of IGAS, it is recommended to contact NHS 111 or GP if: 

• They begin feeling worse
• They are eating less than usual for them
• You spot signs of dehydration
• A baby of less than 3 months has a temperature of 38C or older than 3 months with a temperature of 39C or higher
• They are more tired and irritable than usual 

999 or A&E are recommended if: 

• The child has difficulty breathing
• There are pauses when breathing
• A child’s skin, lips or tongue are blue
• They are floppy and will not wake up or stay awake

Contact an advisor at Medical Tracker to see how your school can monitor concerns around Invasive Group A Strep.