What is Group A Strep?

Group A Strep (also referred to as group A streptococcus or GAS) is the name used for a type of bacteria that is only found in humans.  The bacteria can cause various infections. Most of the infections are not serious. Nearly all children in the Netherlands have had a Group A Strep infection at some point, such as impetigo (a skin rash), strep throat or scarlet fever.

These bacteria can sometimes make people very seriously ill within a very short time frame. In such situations, the bacteria have invaded the underlying tissue or entered the bloodstream. This also depends on the age and vulnerable health status of the infected person. When that happens, it is called an invasive Group A Strep infection. One form of invasive Group A Strep infection is necrotising fasciitis, also known as ‘the flesh-eating bacteria’.

What are the symptoms of an invasive Group A Strep infection?

A person with an invasive Group A Strep (iGAS) infection will usually need to be admitted to hospital. Various severe symptoms may occur:

• Skin infection. Underlying tissues such as muscles or bones may sometimes also be affected, possibly even leading to serious damage to skin and muscle (necrotising fasciitis).
• Deeper infections, such as meningitis, pleuritis, or infections that affect the joints or lungs.
• Puerperal fever (postpartum infection). This is an infection of the uterus after childbirth, sometimes accompanied by sepsis.
• Septicaemia (blood poisoning) leading to low blood pressure and elevated heart rate (septic shock), which may cause organ failure if it persists for too long. Symptoms often include high fever, chills, muscle pain, drowsiness and confusion.

How does an invasive Group A Strep infection happen?

The bacteria are mainly present in the nose and throat and on the skin. Many people carry these bacteria without becoming ill. When they cough, sneeze or talk, tiny droplets containing the bacteria are expelled into the air. If other people inhale the droplets, they could become infected. The risk of a serious infection is higher during or just after chickenpox or a respiratory infection, such as influenza (flu).

A person carrying the bacteria can also infect others by touching things. Hand contact can transfer the bacteria to toys, utensils, dishes and food.

A person is contagious while carrying the bacteria or until the infection is cured. If a person receives treatment with antibiotics, they are still contagious for 24 hours after the first dose of medicine.

Who can get an invasive Group A Strep infection?

Anyone can be infected with these bacteria, but not everyone becomes very ill.

Some people have a higher risk of becoming ill from Group A Strep:

• family members of a person who has an invasive Group A Strep infection
• a woman who has just given birth
• older people (over 65)

People who have a chronic illness, are in poor health, or have impaired immunity are more likely to become more seriously ill.

What can you do to prevent an invasive Group A Strep infection?

It is difficult to prevent exposure to Group A Strep. However, you can take these precautions.

When coughing and sneezing:

• Use a paper tissue. If you do not have a paper tissue at hand, cough into your elbow.
• Use a paper tissue only once, and discard it after use.
• You do not have to avoid all contact with anyone who is sneezing or coughing. However, newborn babies should be kept away from people who are sneezing and coughing.

Frequently wash your hands with soap and water. In any case:

• before preparing food or baby bottles
• before eating food
• after going to the toilet
• after changing a nappy or helping someone go to the toilet
• after cleaning, including wiping tables and counters
• after petting or cuddling animals
• after coughing, sneezing or blowing your nose

How to wash hands:

• Rinse your hands well under running water.
• Take some liquid soap from a dispenser.
• Rub your hands together. Make sure you get soap all over the palms and backs of your hands. Rub soap onto all your fingertips. Do not forget the thumbs. Also rub in between your fingers.
• Rinse the soap off thoroughly under running water.
• Dry your hands thoroughly on a clean towel or paper towel (kitchen roll).

Other than that:

• Do you have a cut or wound that needs to be cleaned? Practice good hygiene and work carefully.
• Does someone in your family have a serious infection involving Group A Strep? Then it may sometimes be necessary to give medicine to other family members to prevent them from getting the infection too. The Municipal Public Health Service (GGD) will consult with the doctor to decide whether this precaution is needed.
• Have you had close contact with someone who has an invasive Group A Strep infection? You may need to closely monitor your health to check for symptoms. The GGD will consult with the doctor to decide whether this is needed.

Is there a treatment for Group A Strep infection?

A person who has an invasive Group A Strep (GAS) infection is often admitted to hospital for treatment. A very serious invasive infection can sometimes lead to death.

Can a person with Group A Strep go to childcare, school or work?

A person who has an invasive Group A Strep (GAS) infection is too sick to go to childcare, school or work. 

A child may go to school or childcare once they are sufficiently recovered. Tell the childcare provider or teacher. They can consult with the Municipal Public Health Services (GGDs) to notify other parents as needed, so parents can be alert to possible symptoms in their children.

When should a child go to the GP?

There are many different viruses that can cause respiratory symptoms. That includes flu and RSV. The symptoms will usually go away on their own. Young children can sometimes have multiple respiratory infections in quick succession. Contact your GP if a child has a respiratory infection or chickenpox, and is becoming increasingly ill.  Or if a child is recovering and then suddenly gets ill again a few days later.  More information about childhood illness (in Dutch) is available on the Thuisarts website.