There are some signs the ‘exceptional’ rates of strep A seen this winter may be starting to decline, latest figures from the UK Health Security Agency show.

Cases of scarlet fever and invasive group A streptococcal infection remain higher than in previous seasons but there has been a recent downturn after the peak in December, UKHSA said.

It is not yet clear if this will be sustained as figures from GP notifications are fluctuating and still above what would be expected for this time of year, public health officials noted.

But the alerts issued at the start of December, which led to high numbers of GP appointments as well as antibiotic shortages, may have helped stop onward transmission, the UKHSA said.

The alerts to the public and health professionals ‘may have succeeded in bringing people forward for clinical assessment and treatment, inducing the sharp increase in notifications in week 49 and reducing onward transmission’, a report from UKHSA said.

‘Ongoing monitoring will continue in the weeks following the start of the school term to assess the impact on transmission’ it continued.

There have been 41,012 notifications of scarlet fever since September with a peak in the week before Christmas of 10,009 notifications.

The last peak season for scarlet fever notifications was 2017 to 2018 when 30,768 reports were received across the entire season.

Officials are still investigating the potential cause of reports of an increase in lower respiratory tract group A strep infections, particularly empyema, in children over the past few weeks.

The increased rates of invasive group strep A infections is likely to be a result of increased rates of scarlet fever and it is likely that reduced exposure during the pandemic has led to higher levels of susceptibility among children, the report added.

‘Prompt treatment of scarlet fever with antibiotics is recommended to reduce risk of possible complications and limit onward transmission,’ UKHSA said.

‘Clinicians should continue to maintain a high index of suspicion in relevant patients for invasive disease as early recognition facilitates prompt initiation of specific and supportive therapy.’

Eight serious shortage protocols for phenoxymethylpenicillin V that were introduced in December to mitigate supply problems and were due to expire have now been extended until the end of February.

Two antibiotics, azithromycin and clarithromycin, have also been removed from the list of medicines that can be supplied as an alternative.

Instead, only amoxicillin, flucloxacillin, cefalexin or co-amoxiclav can be supplied as an alternative to phenoxymethylpenicillin 250mg tablets, 250mg/5ml oral solution and 250mg/5ml oral solution sugar free, as well as 125mg/5ml oral solution and 125mg/5ml oral solution sugar free.

A version of this article first appeared on our sister publication Pulse.