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Primary Care Clinical Update 8 December 2022

 Primary Care Clinical Update 8 December 2022

 1. Group A Streptococcal infections

There has been an increase Group A Streptococcal (GAS) infections in recent months, which has led to at least 15 deaths in children since September. Although GAS rates are higher than expected for this time of year, they have been higher at periods over the last decade as shown in the graph below from the UKHSA. 

GAS causes a range of infections including Scarlet Fever and also more severe invasive disease. For more information on management, see: Scarlet fever: a guide for general practitioners. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649319/

The Centor score can be used to assess the probability of an illness being GAS pharyngitis: Tonsillar exudates, tender anterior cervical adenopathy, absence of cough, history of fever (>38 °C). Penicillin V (or Amoxicillin) is the preferred treatment unless contra-indicated in which case an alternative such as a cephalosporin or clarithromycin can be given.

Scarlet Fever and invasive GAS disease are notifiable and should be reported to the local health protection unit. Contacts (although at higher risk of GAS infection) do not generally need antibiotics unless symptomatic. See contact tracing flowchart for details. Health protection teams are responsible for contact tracing.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/327473/iGAS190308_flow_chart.pdf

This guidance was updated in 2008 and may change again.

https://www.gov.uk/government/publications/invasive-group-a-streptococcal-disease-managing-community-contacts

Antibiotics should only be administered:

1.       To mother and baby if either develops invasive group A streptococcal disease in the neonatal period (first 28 days of life);

2.       To close contacts if they have symptoms suggestive of localised Group A streptococcal infection, i.e. sore throat, fever, skin infection;

3.       To the entire household if there are two or more cases of invasive group A streptococcal disease within a 30 day time period.

Oral Penicillin V is the drug of first choice where chemoprophylaxis is indicated. Azithromycin is a suitable alternative for those allergic to penicillin. Some areas of England are now reporting shortages of liquid antibiotics.

 

2. Low influenza vaccine uptake in pre-school children

The uptake of the nasal flu vaccine among two and three-year-olds is down considerably on previous years whilst flu rates are increasing.

https://www.pulsetoday.co.uk/news/clinical-areas/respiratory/poor-flu-vaccine-uptake-in-pre-school-children-as-hospitalisations-rise-by-70/   

 

3. MHRA approval of Covid-19 vaccine for children 6 months - 4 years

The MHRA has authorised the Pfizer Covid-19 vaccine for use in children aged 6 months to 4 years. This doesn’t mean it is available from the NHS as the JCVI need to make recommendations for government on the use of the vaccine in this age group. If any parents get in touch about vaccination, they can be informed the vaccine is not yet available from the NHS for this age group. If they want more information, they need to contact their MP or the Secretary of State for Health and Social Care as any decision about providing Covid-19 vaccination needs to be taken by the government.

https://www.gov.uk/government/news/pfizerbiontech-covid-19-vaccine-authorised-for-use-in-infants-and-children-aged-6-months-to-4-years


4. Automatic online access to GP records halted until further notice

Automatic access for patient to GP records has been halted for the time being.

https://www.pulsetoday.co.uk/news/breaking-news/automatic-online-access-to-gp-records-halted-until-further-notice/

 

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