Reacción a "Reactions to the increase in 'Streptococcus pyogenes' infections in the UK and the situation in Spain"

The reason for this increase in the UK is unclear. The most widely accepted theory is a decrease in general immunity due to a decrease in the circulation of the bacteria as a result of distancing measures during the pandemic. But it could have been an accumulation of circumstances that will have to be analysed more slowly, such as the coincidence with two respiratory viruses that could favour a more severe infection, such as RSV and influenza, or the change of strains or serotypes, which could be more virulent. However, it is probably too early to know whether there is a real increase in incidence, as incidence is fluctuating and reporting may be delayed.  

In Spain, invasive Streptococcus pyogenes disease (S. pyogenes) is unfortunately not a notifiable disease (NOM), so we do not know if there is an increase in incidence. We studied it in Madrid a few years ago and saw an increasing trend, which then decreased a lot (like other infections) during the covid-19 pandemic, and it was an enigma how it was going to evolve. The feeling now is that there is a relatively large increase, both in incidence and severity, but it is something we need to study better. To this end, a few years ago a national network was created for its study (PedGAS-net), which I coordinate, and through which we are collecting cases. Given this alert, we are going to try to speed up the collection and we hope to have more data in a few weeks. It will also be important to identify the strains and serotypes currently circulating, for which it will be important to work with the National Microbiology Centre.  

For parents, the first thing to do is not to be alarmed, as these serious S. pyogenes infections are very rare, especially the most serious ones. I like to appeal to common sense and assess each child, keeping an eye on the warning signs that paediatricians always mention when faced with an episode of fever, such as significant drowsiness, persistent respiratory distress, vomiting that does not go away or fever that lasts more than 3-4 days, especially if it is high or difficult to reduce. And something we always mention are rashes that do not disappear with acupressure. Sometimes you also have to be careful with rashes that are extensive and very red, like sunburn. Something important (although not 100%, like everything else in medicine) is that strep throat usually occurs without a cold, mucus or cough. It is important to inform parents that in the event of a suspected S. pyogenes infection, health centres, where the staff are excellent professionals, usually have a throat test to find out whether the infection is due to this bacterium or not, if they consider that it should be done. Finally, parents should be urged to keep their children's vaccination schedule up to date according to the recommendations of the Spanish Association of Paediatrics, including chickenpox and flu (the latter between 6 months and 5 years of age, as well as for children at risk).

It is also important to keep children out of school while they have a fever and at least 24 hours after starting antibiotics in the case of bacterial pharyngitis.