The Public Health Agency (PHA) has said there are currently no plans to close schools in Northern Ireland despite an unseasonal leap in the number of scarlet fever and Strep A cases.
It comes just hours after it emerged that a five-year-old child at a West Belfast primary school, where last week a severe case of the Strep A bacterial infection was reported, has died.
The P2 pupil at Black Mountain Primary School became severely ill last week and was treated in intensive care at the Royal Belfast Hospital for Sick Children, but sadly died on Monday evening.
Read more: Five-year-old girl dies from reported Strep A case in Belfast
On Friday the PHA sent a letter to parents of P1 to P3 children at the school in which children were asked to attend a clinic to be seen by a doctor and receive a preventative course of antibiotics.
Black Mountain PS said the girl's death was a tragic loss to the school community.
To date, nine children have died with a form of Strep A. 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 also 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.
The PHA has again urged parents and carers to be aware of scarlet fever symptoms after an increase in the number of cases at schools and nurseries across the region.
It said this follows two years during the coronavirus pandemic when reported cases were lower than usual. Clusters of scarlet fever have been reported at schools and nurseries in Antrim, Belfast, Bangor, Craigavon and Kilkeel.
Dr Joanne McClean, Director of Public Health at the PHA, said the latest figures showed 122 scarlet fever cases were notified in November, much higher than normal.
In terms of the most serious infections linked to invasive group A strep, known as iGAS, 33 cases have been reported to date this year.
She told a media briefing on Tuesday: "We're seeing an increase in Group A Streptococcus circulation in common with the rest of the UK. We are also seeing increases in scarlet fever, which usually circulates in the spring.
"This is happening out of season and that's the unusual bit of this whenever other viruses are in circulation. Part of the reason that we're seeing an uptake in notifications is due to awareness, both parents and GPs are now thinking about scarlet fever."
The PHA said one of the theories around the increased spread of Strep A being considered is the co-circulation of other viruses while a second theory is a link to social mixing patterns post-Covid.
Dr Philip Veal, a health protection consultant, said there are currently no plans for widespread school closures.
"We understand that if schools are closed, the pupils that attend them will still congregate in other settings, whether day care with friends or socially," he explained.
"The evidence suggests that the relevant impact on the transmission of infection is actually minimal. There is some evidence to suggest that what you can actually do is increase the exposure between infected kids and vulnerable elderly relatives and seed off infection into the community.
"The science for most infectious diseases, and scarlet fever and Group A strep is no different, does not support widespread closures of schools to halt transmission."
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