By Tiny Hearts

Group A Streptococcus - How to recognise the signs and keep your family safe

What is Group A Streptococcus?

Group A Streptococcus (Strep A) is a bacteria that usually causes mild diseases like sore throats and school sores. For the most part, it is a common infection that shows as a mild illness that many people recover from without needing to see a doctor. However, the cases where it becomes more serious and life-threatening are when the bacteria invade the body and enter areas such as the blood. This is called invasive Group A streptococcal disease

How common is it? How many people have been infected with it?

According to data from the Department of Health's National Communicable Disease Surveillance Dashboard, there were 1163 cases of iGAS in Australia in 2022. A study from the Murdoch Children't Research Institute found the number of children admitted to hospital with strep A rose from 23 in 2020 to 107 in 2022. In 2022, Victoria had 42 cases of invasive strep A infections at RCH and Monash Children's hospital. Two Victorian children died from the illness last year.

As of January 13, there have been 52 infections recorded in 2023. The WHO has documented a rise in the number of invasive strep A cases in a number of countries around the world. There have been recent headlines in the UK where there was an increase in the number of infections, causing tens of thousands of cases of scarlet fever and the deaths of 25 children.

What is causing the spike in numbers?

There are a few theories on the cause of the spike in numbers. One of these is that because of the lockdowns, people were all insulated from infectious bugs, including strep A. This means that fewer people were getting low-grade infections of the strep A bacteria, and this reduced people's immunity to it. Another theory is that the rise in other respiratory illnesses, such as influenza, means more people are getting sick. Viruses can cause damage to the lining of the throat, which opens up the opportunity for the invasion of bacteria into the bloodstream.

What are the symptoms of Group A Streptococcus?

The symptoms your child shows will depend on where the infection develops in the body.

Symptoms of strep throat:

  • pain when swallowing
  • fever 
  • muscle aches and pains
  • tiredness

Symptoms of scarlet fever

  • red, sore throat 
  • swollen glands  
  • fever 
  • red blotches on the skin

Symptoms of Impetigo 

  • red sores on the skin that form blisters  
  • blisters pop and leave a moist area with a yellow/brown crust at the edge 

Symptoms of cellulitis 

  • skin is red, painful and swollen
  • skin feels tight and warm to touch

Signs the bacteria is progressing to invasive Group A Streptococcus

So if strep A is a common illness that can self-resolve, how can you tell when your little one has the more sinister Invasive Group A Streptococcus? Look for the same red flags and signs of any critically unwell child. If you see any of these things, take your child to the hospital. 

Signs of invasive strep A: 

  • Fevers/chills 
  • Dizziness 
  • Shortness of breath 
  • Stiff neck 
  • Nausea 
  • Vomiting 
  • Red skin infection 
  • Red sunburn-like rash
  • Limb pain and reluctance to walk
  • Abdominal pain
  • Lethargy
  • Decreased urine output

    Why Invasive Group A Streptococcus is so serious

    Invasive Group A streptococcus is when the bacteria infect a normally sterile part of the body such as the blood, meninges, joint spaces, heart muscles and bone. When these areas are infected, it can cause Group A streptococcal toxic shock syndrome (STSS). This can result in disseminated intravascular coagulation, which is when the blood clots inside the blood vessels when it isn't supposed to. This can cause blockages in vessels leading to vital organs, and at the same time, puts the patient at risk of bleeding out. Another rare but serious complication of Group A strep is Necrotising fasciitis, also called the "flesh-eating disease". This is a bacterial infection that can spread rapidly and lead to sepsis, organ failure and death. This happens when the bacteria invade the skin, multiply quickly and releases toxins that cause blood to clot in the blood vessels. This results in the death of the tissues in the skin and muscle.

    How is it treated?

    The earlier treatment can be commenced, the better. That is why recognising signs of a critically unwell child and being able to tell it's more than just a normal bacterial infection is so key. Strep A is treated with antibiotics. 

    How do kids catch it?/How is it spread?

    The bacteria is spread through large respiratory droplets (coughing, sneezing) or direct contact with infected people.

    How can I prevent it?

    The best way to protect yourself from Group A Strep is similar to any other bacteria, practice good hygiene and wash your hands often. Avoid contact with people who are infected with the bacteria. Get treatment for skin infections promptly to prevent them from spreading.

    Is there a vaccine available for it?

    Currently, teams are working on developing a preventative vaccine, but at the moment, there are no current vaccines available.


    • Thanks for mentioning that invasive strep A causes a sunburn-like rash. My husband and I noticed that our son has a weird rash and high fever today. It would be good to take him to urgent care to see if this is indeed invasive strep A.

      Eve Mitchell on

    • This really worries me because some those red flag symptoms are also very similar to a cold or stomach bug. So every time our kids have a fever or vomiting for example, should we be taking them to ED? Because they are symptoms of invasive strep A?

      Brittany on

    • My 9 month old presented to hospital with high fevers, loss of appetite, lethargy and decreased urine output. Upon assessment she had a consistently high heart rate so was admitted to do further testing. She was diagnosed with Strep A that developed into Sepsis which was thankfully treated in time to have no long lasting effects. We are forever grateful for seeing this post beforehand and knowing the red flags to look out for with a critically ill child. My heart goes out to the families who have been affected by this nasty bug.

      Emma on

    • The theory that lockdowns have caused some sort of “immunity deficit” is not supported by science — at all. The one that is supported by science is that COVID impairs your immune system allowing what we’re previously fairly benign infections to become major ones.

      Just this past week a paper was released that showed the CD8 response (an immune marker) was impaired after COVID -19 infection, in the same way that it is impaired when someone has HIV. COVID is causing catastrophic illness in kids and we’re doing nothing about it.

      There are groups in almost every country that are organizing to challenge the governments on this “let ’er rip” strategy and how it’s affecting our population but especially our kids. Find one in your area and contribute in any way you can!

      Follow the science. ✌️

      Kate on

    • I too have experienced the consequences of poor communication within ED. I’m so sorry your family had to go through all of this. Thank you for sharing Archie’s story.

      Bec on

    • My daughter had strep that became Scarlett fever in November last year.
      It’s actually incredible how quickly she declined, and the second I saw the blotches over her body I knew what it was and got antibiotics via a video consult as it was a Sunday and the ED was rammed.
      My heart is shattered for Archie and his parents 🎈

      Katina on

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