Death of child (4) from strep A confirmed as parents urged to keep children with signs of illness at home

Warning over ‘significant rise’ in viral infections as children’s hospitals say they are at ‘critical capacity’ due to ‘perfect storm’ of factors

The Health Service Executive (HSE) has confirmed the death of a four-year-old child from the bacterial infection known as strep A.

The death occurred in the north Dublin/northeast health region and the HSE, which had been investigating a link between the death and the illness, said a local public health team is supporting the child’s family. It follows the death of a five-year-old girl from a severe form of strep A in the Belfast area.

Concern about strep A and a “significant increase” in viral infections in the community has prompted the HSE to write to all schools urging them to encourage parents to ensure children with signs of illness to be kept at home.

Children’s hospitals in Dublin said on Wednesday they are at “critical capacity” due to the high number of patients attending paediatric emergency departments (EDs) and the number of very sick children already in these hospitals.

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The paediatric services in Children’s Health Ireland at Temple Street, Crumlin, Tallaght and at Connolly Hospital, Blanchardstown said they were experiencing extreme pressure in demands for services.

“This is a perfect storm – there are high levels of viruses in the community at the moment, and due to earlier appropriate measures to protect from Covid-19, families have not experienced illness in their children who were born during lockdown, and we also have some very sick babies presenting to our EDs who need acute care. We need to concentrate our resources on these sickest children,” said Dr Ike Okafor, clinical director in Children’s Health Ireland.

The hospital umbrella group urged parents or guardians to attend local hospitals or care centres where possible with less severe illness to help ease pressure on EDs.

Dr Éamonn O’Moore, director of the HSE’s Health Protection Surveillance Centre, said news of a child’s death from strep A “will be worrying for parents” but it was important to know that most children who get ill from the bacterial infection have a mild illness that can be treated with antibiotics.

He said the centre was monitoring strep A and scarlet fever, cases of which have also risen, and that there was as yet “no evidence that a new strain is in circulation”.

“There is likely a combination of factors as to why there has been a slight increase in infection this season, including increased social mixing following the pandemic, compared to previous years, as well as increases in other respiratory viruses,” he said.

Strep A infections are usually mild and may result in sore throat or scarlet fever, and are normally treated with antibiotics. However, in rare cases it can develop into a more serious infection, known as invasive Group A strep (iGAS), that can cause lethal sepsis, shock or meningitis.

HSE chief clinical officer Dr Colm Henry said it was unlikely that the prophylactic use of antibiotics to prevent infection by strep A would be recommended for healthy children in a creche or class where there has been a case of the infection.

“A second invasive case would be exceptionally rare. Given that it is exceptionally rare, the benefits of providing antibiotics to contacts who are well and are at low risk are doubtful,” he told The Irish Times.

Dr Henry said the health protection facility, as part of the HSE’s public health services, would meet on Thursday to consider antibiotic use in particular settings where there have been cases of strep A.

There has been a small increase in strep A cases since the start of October. So far this year there have been 56 cases in the State, 15 of which were in children aged under 10 years of age. This compares with 22 cases in the same age group for the same period in 2019. Twenty-two of this year’s cases have been reported since the beginning of October, five of which were in children aged under 10. Two people aged over 55 have also died of the infection this year.

Parents are being advised to look out for infections that cause various symptoms such as sore throat, fever, chills and muscle acres. Parents are urged to contact their GP if their child is getting worse, feeding or eating less than normal, and has had a dry nappy for 12 hours or more or shows other signs of dehydration.

The HSE has sent a letter to all schools warning of a “significant increase” in viral infections and concern over serious bacterial infections such as strep A. The letter, from Dr O’Moore and Dr Abigail Collins, national clinical lead for public health among children, asks parents to keep children at home if they are unwell.

“Children with symptoms are more likely to spread infections. For example, they may spread flu or bacterial infections. Staying home when unwell will help prevent spread to other children, families and staff,” says the letter, which adds that there has been a large increase in general viral infections among children and young people this winter.

While there is no vaccine against many viral illnesses or strep A, it says that making sure children are up to date on al

l recommended vaccinations will help stop them getting an infection and make them less likely to be unwell if they do get an infection.

The nasal spray flu vaccine is available for children aged two to 17 years, which helps protect against severe infection with flu and onward spread.

Anyone concerned about their child is advised to check hse.ie, where there is information on coughs, colds, fever, rashes and symptoms of concern.

There is also advice on when to contact your GP or go to a hospital emergency department.

Simon Carswell

Simon Carswell

Simon Carswell is The Irish Times’s Public Affairs Editor and former Washington correspondent

Carl O'Brien

Carl O'Brien

Carl O'Brien is Education Editor of The Irish Times. He was previously chief reporter and social affairs correspondent