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Health authorities on watch for serious bacterial infections in children as cases surge overseas

Queensland doctors are on alert for cases of invasive group A streptococcus disease (iGAS) after several countries reported a recent spike.

Paediatric infectious disease specialist at the Queensland Children's Hospital Adam Irwin said group A streptococcus is an "extremely common" bacteria that causes a range of conditions which often affect children.

These include strep throat, impetigo (or school sores) and scarlet fever.

Dr Irwin said invasive infections "occur rarely" but are of most concern and need to be recognised and treated early.

"The kinds of conditions that we call invasive group A streptococcus are pneumonia, sepsis, bone and joint infections," he said.

"It's really important that we recognise the signs of those invasive and serious infections so that they can get antibiotics promptly."

Dr Irwin said features of a serious infection in children include:

  • Difficulty breathing
  • Pain and restlessness or a change in behaviour
  • Cool and blotchy skin

"If they have any of those features then I'd encourage them to be seen in an emergency department promptly," Dr Irwin said.

The most common antibiotic for treatment of the infection is penicillin.

Transmission can be reduced through hand washing, using tissues and staying home when unwell.

"Part of the reason why we saw many fewer group A streptococcal infections over the last couple of years is because we were all socially distancing better … and were much more careful about how we interacted with people when we had symptoms," he said.

'Uptick' in cases here and overseas

Dr Irwin said while severe infections are rare, they have been observed "more frequently than expected" in the UK and Europe over the last few months.

He said doctors in Australia are "keeping a very close eye on the possible emergence and the possible increase in invasive infection."

A Queensland Health spokesperson said there were 377 cases of invasive group A streptococcus (iGAS) between January 1 and December 18 in 2022, which is a 20 per cent increase on the five-year average.

"[In 2022] there were nine deaths reported in Queensland that were attributed to iGAS infection, which is comparable to previous years," the spokesperson said.

A federal Department of Health spokesperson said iGAS only became a notifiable condition in all Australian states and territories in 2022.

"So, historical data at a national level is not available," the spokesperson said.

Health authorities in both New South Wales and Victoria have urged the public to be aware of the signs of iGAS after a recent increase in cases

Professor Michael Good from Griffith University's Institute for Glycomics said the reason for the "uptick" was not clear.

"It doesn't seem to be a novel strain that's circulating, it's not unique to Australia, my colleagues are seeing it in Canada and in the United Kingdom," he said.

"It may be due to the fact that we're seeing more other viral infections, which together with strep can make it a much more serious condition," Professor Good said.

In December 2022, the World Health Organization said countries including the United Kingdom, France, Ireland, Sweden and the Netherlands had reported an increase in iGAS and scarlet fever cases.

The UK Health Security Agency said between September 2022 and January 2023 it recorded 151 deaths in England from iGAS, including 29 children under the age of 18.

England had 35,616 notifications of scarlet fever during the same time period.

Professor Good said "the world is a global village" and iGAS and scarlet fever cases could rise in Australia heading towards this winter.

Long held hope for a vaccine

Group A streptococcus also causes rheumatic heart disease, which can lead to heart failure and strokes.

Professor Good said it had been a decades-long aim of his team to eradicate rheumatic heart disease, which thrives in areas of social disadvantage and disproportionately affects First Nations people, largely due to overcrowding.

"Our Indigenous population have the highest rates of rheumatic heart disease in the world and it's always caused by streptococcal infection, no other infection causes rheumatic heart disease," he said.

"So, if we can stop the streptococcal infection by a vaccination we'll prevent all cases of rheumatic heart disease."

The vaccine and immunology expert said Griffith University is starting a phase one vaccine trial in adults in Canada.

If the vaccine proves safe and effective, the goal is to trial it in younger age groups.

"We would see ultimately a vaccine being given to pre-school aged children to prevent tonsilitis and the consequences such as invasive strep disease in that population," he said.

Dr Irwin also highlighted the scourge of group A streptococcus infections in First Nations communities.

"It's really important for us in Queensland and other parts of Australia that we recognise the burden that group A streptococcus continues to cause in those communities," he said.

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