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Resurgence of group A streptococcal disease in children

BMJ 2023; 380 doi: (Published 10 January 2023) Cite this as: BMJ 2023;380:p43
  1. Alasdair Bamford, consultant in paediatric infectious diseases1,
  2. Elizabeth Whittaker, consultant in paediatric infectious diseases2
  1. 1Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to: E Whittaker e.whittaker{at}

High risk of transmission requires vigilance in all age groups

Clinicians in the UK have recently seen a notable increase in conditions associated with group A streptococcal infection, specifically scarlet fever in children and invasive group A streptococcal disease in all ages.1 In England, from 12 September 2022 to 5 January 2023, 151 deaths from any cause were recorded within seven days of an invasive group A streptococcal infection (group A strep), with 15% (23) in children aged 10 years and under; 343 cases of invasive group A strep were reported in children younger than 18, with 29 deaths in this age group (case fatality rate 8.2%).1 This is out of keeping with the usual seasonal variation, with cases usually highest in spring. Similar signals have been observed in other countries,23 bringing group A strep into the spotlight globally.

Both scarlet fever and severe group A strep are notifiable diseases in England, allowing detailed monitoring of trends and outbreaks as well as surveillance of circulating strains. Rates of scarlet fever in England had fallen substantially and consistently since the early 20th century until an unexplained increase in 2014.4 This was followed by further relatively high annual peaks in spring until March 2020, when case notifications fell substantially during …

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