Child Strep A deaths in the UK rise to 19 as government admits penicillin shortage

Increase in cases most likely caused by high amount of circulating bacteria and increased social mixing, say health chiefs

The funeral of Stella-Lily McCorkindale, five, who died of Strep A, takes place in Belfast. Getty
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New figures show at least 19 children have died across the UK from invasive streptococcal A disease.

The updated tally comes as the British government acknowledged supply problems with some of the drugs used to treat infections caused by the bacteria.

Latest data from the UK Health Security Agency shows 16 children have died in England since September.

The three other deaths were recorded in Belfast and Wales.

It is understood that health officials do not believe the number of scarlet fever infections has yet peaked, suggesting more deaths are likely.

Meanwhile, the government has introduced "Serious shortage protocols" for three types of oral solutions used in paediatrics — Phenoxymethylpenicillin, which is also known as penicillin V.

This means pharmacists can legally supply alternative forms of the medicine if they do not have the specific formulation stated on the prescription, such as an oral solution.

The protocols, which cover the entire UK, are intended to lessen the need for patients to return to their GP for a different prescription when they cannot get hold of a medicine.

Penicillin comes as liquid, sugar-free liquid and pills.

Health Minister Will Quince acknowledged that increased demand had left some pharmacists unable to meet prescriptions.

"These serious shortage protocols [SSPs] will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients, and GPs," he said.

Mr Quince said the situation was "temporary" and "localised" because of the high numbers of Strep A and scarlet fever cases.

The government was working with manufacturers and wholesalers to speed up supplies, he added.

The Health Ministry said SSPs were "standard procedure" and were used often "to manage temporary and potential medicine supply issues".

But pharmacists said they were “baffled” as to why it had taken so long for the government to introduce the protocols.

“This is a step in the right direction, and it will make the journey easier for patients and make it easier for pharmacists," Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, told BBC Radio 4.

“However, we’ve raised this concern about the shortage of antibiotics for many days now and we’re baffled by the fact that this has taken so long for things to move forward and for things to be planned accordingly.

“What happens now is the pharmacist will be able to prescribe an alternative antibiotic, according to the protocol.

“The supply of antibiotics generally at the moment is very patchy and it’s very difficult to get hold of them.

"As soon as something becomes available it just flies off the shelves because of the high demand.

“But this is certainly a step into in the right direction. However, this should have happened much earlier.”

What is strep A? - video

Group A strep bacteria can cause many different disorders, from minor illnesses to deadly diseases.

Illnesses caused by Strep A include the skin infection impetigo, scarlet fever and strep throat.

While the vast majority of infections are relatively mild, sometimes the bacteria cause a life-threatening illness called invasive Group A Streptococcal (iGas) disease.

The health agency has said there is no evidence that a new strain is circulating and the rise in cases is most likely caused by high amounts of circulating bacteria and increased social mixing.

It said that, since September, there have been 7,750 notifications of scarlet fever, more than three times the number in the last high season in 2017-2018.

There have been 111 iGas cases in children aged between one and four, and 74 cases in children aged five to nine.

Since September, 74 people of all ages have died in England.

“Scarlet fever and ‘strep throat’ will make children feel unwell but can be easily treated with antibiotics," said Dr Colin Brown, deputy director of the health agency.

“Symptoms to look out for include fever, sore throat, swollen glands, difficulty swallowing and headache.

“Scarlet fever causes a sandpapery rash on the body and a swollen tongue.

“NHS services are under huge pressure this winter, but please visit nhs.uk, contact 111 online or your GP surgery if your child has symptoms of scarlet fever or ‘strep throat’ so they can be assessed for treatment.”

Dr Brown said parents should also look out for signs that their child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection.

“Public Health Wales has confirmed it is investigating the deaths of two children as possible iGas cases,' a spokesman for the health authority in Wales said.

“Due to the risk of identification, Public Health Wales will not confirm numbers of deaths lower than five.”

But the families of Hanna Roap, 7, from Penarth in South Wales, and a child from Powys who has not been identified, have confirmed the cause of death of both children was iGas.

“The majority of those who become critically ill with iGas do so because of sepsis," said Ron Daniels, chief executive of the UK Sepsis Trust.

“This is why co-ordinated education and public messaging around both Group A Strep and sepsis symptoms is critical to ensuring people can be diagnosed and treated quickly and to prevent further lives lost."

Online health diagnoses - in pictures

Mr Quince explained why the protocols had been activated.

“The increased demand for the antibiotics prescribed to treat Strep A has meant some pharmacists have been unable to supply the medicine shown on the prescription," he said.

“These serious shortage protocols will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients and GPs.

“We are taking decisive action to address these temporary issues and improve access to these medicines by continuing to work with manufacturers and wholesalers to speed up deliveries, bring forward stock they have to help ensure it gets to where it’s needed, and boost supply to meet demand as quickly as possible.”

The Royal Pharmaceutical Society said pharmacists should be allowed to make minor changes to prescriptions without the need for a protocol.

“Ultimately we’d like to see a change in the law which makes the whole process of supply of medicines easier and quicker for both pharmacists and patients," said Thorrun Govind, chairman of the association in England.

"We urge the government to amend medicines legislation to allow pharmacists to make minor amendments to a prescription without any protocol being needed.

“At present a prescription can only be changed by the prescriber, which causes unnecessary workload for GPs and delays for patients.

“We want to see all pharmacists across the UK enabled to change prescriptions and be able to supply a different quantity, strength or formulation of a medicine — for example, changing capsules to tablets — on a daily basis, to avoid unnecessary bureaucracy and the need for an SSP to be developed, signed and authorised by a minister.

“In effect, it would mean that pharmacists can help patients straight away.”

Updated: December 16, 2022, 11:43 AM
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