The Health Service Executive is investigating the death of a four-year-old child which may be linked to the bacterial infection known as Strep A.

Dr Eamonn O'Moore, Director for National Health Protection with the HSE and HPSC, said that the illness is one of a number of conditions that are being considered as contributory factors.

"This is still being considered actively, so as I speak to you, we haven't confirmed that, it is subject to further laboratory investigation," he said.

"But it is reasonable to say it is among the differential diagnoses at this time."

Speaking on RTÉ's News at One, he said there had been 55 confirmed cases of invasive Group A Streptococcal disease (iGAS) in Ireland to date this year.

Dr O'Moore said two deaths had been associated with this illness, both of which were in older people.

The Health Protection Surveillance Centre (HPSC) said that of the 55 iGAS cases in Ireland this year, 14 were in children aged under 10 years old compared to 22 cases in children aged under 10 for the same period in 2019.

The HPSC said that there "has been a small increase in Invasive Group A Streptococcal (iGAS) in Ireland since the beginning of October".

"A common presentation of iGAS in children can be scarlet fever which causes the following symptoms: fever, a raised rash which can feel rough to the touch like sandpaper, sore throat, and a swollen tongue.

"Whilst iGAS infections, including scarlet fever, are common; the more serious iGAS infections are rare."

Dr O'Moore said the child’s death occurred in the Public Health Group 'Area A', which encompasses the northeast of the country and north Dublin.

He said that during the pandemic the HSE had seen a reduction in Strep A infections reported to them, adding that in pre-pandemic years there was a downward trend in terms of cases reported.


Read more:
What is Strep A and what should people look out for?


'Things become dangerous when the bug becomes invasive'

Dr O'Moore said these are common bacteria and a common source of infection that are often usually 'mild and self-limiting'. He said they cause infections like tonsilitis and scarlet fever.

"When things become serious and dangerous is when the bug becomes invasive....this is where the bug gets into parts of the body where it's not normally found such as the lungs and the bloodstream, and in those circumstances, things can be very serious indeed."

Dr O'Moore said the symptoms to look out for include sore throat, fever, chills and muscle aches.

He advised parents to trust their own judgement if they felt their children were getting worse and to contact their GP in that case.

He said if a child had any difficulties in breathing, a parent should call 999 or go to the emergency room.

Dr O'Moore said the illness can be treated with antibiotics and warned that this is an infectious disease.

He said they were examining guidance concerning whether close contacts of a case should receive preventative antibiotic treatments.

He said it was reasonable to expect more cases in the days and weeks to come.

Five-year-old child dies in Belfast

A five-year-old child at a Belfast primary school which last week reported a severe case of Strep A has died.

Black Mountain Primary School described the death of P2 pupil Stella-Lilly McCorkindale as a "tragic loss".

"The thoughts of the entire school are with Stella-Lily's family and friends at this sad and difficult time," the school said in a statement.

"Stella-Lily was a very bright and talented little girl, and very popular with both staff and children, and will be greatly missed by everyone at school.

"To assist in supporting our pupils and staff at this sad time, additional trained staff from the Education Authority Critical Incident Response Team have been engaged and will be providing support to the school."

It comes as eight other children in England and Wales have died with a form of Strep A.


Symptoms

Strep A infections are usually mild and can be easily treated with antibiotics.

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

There has been a big leap in the number of scarlet fever cases.

Symptoms of scarlet fever include sore throat, headache and fever, along with a fine, pinkish or red body rash with a "sandpapery" feel.

On darker skin, the rash can be harder to see but will still be "sandpapery".

Strep A infections can develop into a more serious invasive Group A Strep (iGAS) infection - though this is rare.


Last week, the Public Health Agency in Northern Ireland urged parents and carers to be aware of scarlet fever symptoms after an increase in the number of cases at schools and nurseries.

It said this follows two years during the coronavirus pandemic when reported cases were lower than usual.

It said clusters of scarlet fever have been reported at schools and nurseries in Antrim, Belfast, Bangor and Craigavon.

Derry-based GP Dr Nicola Herron said that despite the increase in incidents of Strep A, it will only be a "very small number of cases" that might have tragic consequences.

She said: "Two years of lockdown, where we had very little in the way of any infections other than Covid, has meant that our immune systems have gotten a little bit undertrained."

Speaking on RTÉ's Today with Claire Byrne, Dr Herron urged parents to be aware of the symptoms of Strep A and said that if a child has a high temperature not to send them to creche or school as even if they do not have Strep A, any spread of illness can leave other children vulnerable.

She said GPs were seeing lot of sore throats and chesty coughs persisting for weeks, and while most children are managing, Strep A has a "personality of its own".

"It comes with a rash that feels like sandpaper it's really rough, the tongue becomes red with white spots and children generally get more sick than they were three or four days beforehand and can get swollen glands underneath the chin," she said.

She said knowing the signs was knowing the difference between a sick and ill child, where they are off drinks and food and are lethargic, urine output goes down, they are much more unwell and do not respond to treatment.

Speaking on RTÉ'S Six One, Dr Scott Walkin, Clinical Lead in Infection Control with the Irish College of GPs, urged parents to do everything possible to prevent the spread.

He said that Strep A was a common bug, frequently found at the back of the nose and throat and the most common ailment is a sore throat, not a very severe illness.

He said it can travel to other parts of the body, and if it multiplies can cause serious illness.

He said that there was no one symptom that will definitely point to a diagnosis, but it was about overall appearance and findings of the person.

He added that public health advice will help prevent the spread, vaccination was important and that anyone who is eligible for flu vaccine or a Covid booster, practise cough etiquette and ventilate rooms, adding that hand washing helps as well.

Meanwhile, the UK's Heath Security Agency has said that local health protection teams can give antibiotics to groups of children where there has been a Strep A outbreak.

UKHSA deputy director Dr Colin Browne said there was "long-standing guidance" that enables health protection teams to assess the situation in schools and nurseries to consider antibiotic prophylaxis for "either a group of children in certain classes or an entire nursery school".

He reiterated there is no evidence to suggest there had been a change to the circulating strains of Strep A to make them more severe.

Additional reporting PA