Updated on 22nd December 2022
Failed Contact AccurX text Template for Strep A related cases
We have created this text template to support closure of failed contact cases relating to strep A. You can send this in an AccuRX link:
Dear Patient
We have tried to contact you but been unable to get through. The out of hours service is currently managing very high levels of demand. At this stage, we will not make further attempts to ring you.
This link has information you will find helpful, including things to watch out for & when to seek more urgent advice.
If your symptoms are worsening, please re-contact 111/ 111 online again. Alternatively, contact your own GP when they reopen.
NHS England Latest Guidance
The latest NHSE guidance can be found here - www.england.nhs.uk/publication/group-a-streptococcus-communications-to-clinicians
UKHSA National Guidance Update
The UK Health Security Agency have issued this recent update relating to the unusually high number of Invasive Group A streptococcus (GAS) infections currently being identified, particularly amongst children. There has also been a marked increase in Scarlet Fever notifications.
Key recommendations relevant to your work in IUC include :
- Having a low threshold to consider & empirically prescribe antibiotics to children presenting with features of GAS infection, including where secondary to viral respiratory illness.
- Clear safety netting: Parents of children with presumed viral infection should be given information on features suggestive of clinical deterioration and secondary bacterial infection, inclusive of when and how to seek further help.
- Low threshold for prompt referral to secondary care of any child with persistent or worsening symptoms
- Throat swabs – we recognise that these are unlikely to change management in the OOH setting. However, if considering swabs as part of the national update please note that charcoal swabs are available from bases for patients to collect and self swab.
The UKHSA have encouraged all clinicians to be vigilant for those who may have or be at risk of invasive disease, as early recognition and prompt treatment can be lifesaving.
A key message within all of this is the recognition of the unwell patient, and we are keen that this is at the forefront of our assessment, as always. We have compiled a series of resources you might find helpful in relation to the recent UKHSA announcement below.
Recognition of Unwell Children
As ever, early recognition and assessment of the sick child is important, regardless of the aetiology of the illness.
We would encourage all clinicians to continue to use their clinical judgement and seek advice and support if required from colleagues on shift if uncertain.
You may find the resources below helpful
- Normal Paediatric Reference Ranges – available on the toolkit
- Sepsis Trust Infographics: for those under 5and 5-11 years.
- The NICE Traffic Light System for identifying risk of serious illness in under 5’s
Strep A, Sore Throats & Scarlet Fever
Group A Streptococcus
Group A streptococcus can cause a diverse range of infections that typically affect the respiratory tract, skin and soft tissue. Examples include tonsillitis, impetigo, and scarlet fever.
Invasive Group A Streptococcus (iGAS) infections are rare but can occur when the bacteria invades a normally sterile body site, such as the blood. IGAS infections can be extremely severe and prompt recognition is essential.
Public Health Notification
Scarlet fever and Invasive Group A Streptococcal infections are notifiable diseases and all cases should be reported to local Health Protection agencies. You can find further information on how to do so on the toolkit here
Sore throat stratification : Fever pain / Centor Criteria
NICE CKS advises that we consider using the FeverPAIN or CENTOR criteria to determine the likelihood of streptococcal infection in those who present with sore throats.
A decision to treat tonsillitis with antibiotic in children can be guided by a feverPAIN score of 3 or more (this is a lower threshold in light of increased invasive Group A Strep incidence), in combination with clinical judgement.
Note FeverPain is appropriate for those over 3 years.
Scarlet Fever
Scarlet fever is a clinical diagnosis. Our local Remedy website has recently updated guidance on symptoms of Scarlet Fever, alongside advice on antibiotic choice and duration here .
NICE CKS has additional information on when to suspect scarlet fever.
Please note that on darker skin the rash can be harder to see and may be more readily identified by it’s texture, which can feel like ‘ sandpaper’. Further images to assist your recognition of the rash in those with darker skin can be found via this link.
Information for those with Scarlet Fever
- Please provide patient informationfor those with Scarlet fever.
- Those affected should exclude themselves from school/ the workplace for 24 hours after antibiotics have started and take precautions to prevent passing on infection.
- Care should be taken to avoid contact with people at high riskof Scarlet fever complications
Safety Netting
Please continue to safety net as you normally would, and encourage parents to seek help if they are concerned about a clinical deterioration as per UKHSA guidance.
The Healthier Together Website has a host of safety netting and parent information sheets that include those for sore throats, fevers and other childhood illnesses.
You can signpost this website to patients by sending them a link to a particular page via AccurX. There is also an option at the top of the website to convert information to a range of different languages.
The UK Health Security agency has produced a document called 5 ways to protect your under 5s this winter. You may want to share this with parents.
Antibiotic Prescribing
Remedy has local guidance on Antibiotic choice and duration in Scarlet Fever and acute sore throat. Please note the duration of antibiotic course for Scarlet fever varies depending on whether a penicillin based or non-penicillin based antibiotic is chosen.
Some pharmacies are experiencing difficulty in obtaining supplies of liquid antibiotics. In these instances solid dosage forms of antibiotics can be prescribed (tablets or capsules) and these can be crushed or dispersed in water. More information on how to do so can be found here:
Due to penicillin shortages, community pharmacists are currently able to issue an alternative appropriate antibiotic where they do not have penicillin in stock under Serious Shortage Protocols (SSPs) from The Department of Health and Social Care (DHSC). In order for them to do so, when issuing any Penicillin V script, please write the indication for the prescription and the following wording so that they can use clinical judgement in making a switch:
e.g. “Phenoxymethylpenicillin 250mg tablets. TWO (500mg) FOUR times a day for TEN days. Indication – sore throat. Please change as per BNSSG guidance using SSP if OOS”.
Texting the patient the EPS code and the patient’s NHS number can be helpful should the nominated pharmacy not have the medication available for any reason. In such cases, the pharmacy can ‘return’ the prescription to the ‘spine’ for another pharmacy to access with the assistance of the EPS code. If the EPS code has not been provided, the nominated pharmacy should be able to provide this to the patient also.
Tags:group agroup a strepscarlet feversore throatstrep