Health Alert: Increase in Group A Streptococcal Infections

Why was the alert published?

On 15.09.23, NSW Health released a health alert highlighting that Group A Streptococcus (GAS) infections have increased in July and August 2023, particularly in children (1). https://www.health.nsw.gov.au/Infectious/alerts/Documents/2023/20230915-gp-gas-alert.pdf

It is important to note that notifications for Acute Rheumatic Fever (ARF) are reported as being double the baseline of notifications of the last three years.

Non-invasive vs. invasive GAS infection

Most GAS infections are non-invasive and include pharyngitis and impetigo.

Invasive GAS infections are identified from usually sterile sites (e.g., blood, joint fluid), and complications may include sepsis, scarlet fever, necrotising fasciitis, ARF, and glomerulonephritis. ARF and subsequent rheumatic heart disease (RHD) are the most severe and life-threatening post-streptococcal diseases (2).

There is evidence that preceding respiratory infections (such as influenza) may lead to a higher risk for adverse outcome of GSA infections in children (1).

Treatment

Commonly, non-invasive GAS infections act as a precursor to ARF and RHF, and adequate first-line treatment becomes vital in preventing invasive GAS infections (2). The NSW Health Alert includes guidelines for management of non-invasive and invasive disease, incl. ARF (1). More information is also available on health pathways (3). If you suspect sepsis, consider a first dose of appropriate IV or IM antibiotic and arrange immediate transfer to hospital (1).

Who is particularly at risk?

Aboriginal and Torres Strait Islander and Maōri people display a higher disease burden of GAS (1, 2), and disease incidence is particularly high in the very young and very old (4).

Media releases

NSW Health has released an additional community facing article about the increase of GAS infections (5).

Another useful guideline is the flowchart from e Therapeutic Guidelines for assessing and managing sore throats Topic | Therapeutic Guidelines (hcn.com.au), and Therapeutic Guidelines has a podcast available on the topic (6).

Sources:

1) NSW Government, NSW Ministry of HealthABN 92 697 899 6301 Reserve Rd St Leonards NSW 2065Locked Mail Bag 2030 St Leonards NSW 1590Tel. (02) 9391 9000 Fax. (02) 9391 9101Website. www.health.nsw.gov.au

2) May PJ, Bowen AC, Carapetis JR. The inequitable burden of group A streptococcal diseases in Indigenous Australians. Med J Aust. 2016. The inequitable burden of group A streptococcal diseases in Indigenous Australians | The Medical Journal of Australia (mja.com.au)

3) Community Health Pathways.

Hunter New England. Acute Rheumatic Fever (ARF) - Community HealthPathways Hunter New England

Central Coast. Acute Rheumatic Fever (ARF) - Community HealthPathways Central Coast

4) Cannon JW, Bowen AC. An update on the burden of group A streptococcal diseases in Australia and vaccine development. Med J Aust. 2021. An update on the burden of group A streptococcal diseases in Australia and vaccine development - PMC (nih.gov)

5) NSW Government. Be on the lookout for serious bacterial illnesses. 13.09.2023. https://www.health.nsw.gov.au/news/Pages/20230913_00.aspx

6) Australian Prescriber Podcast. Therapeutic Guidelines Sore Throat. Therapeutic Guidelines Sore Throat (tg.org.au)