The reason respiratory infections have gripped the nation before Xmas

What is Strep A infection?

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Recent weeks have seen a surge of reports of various respiratory infections — including Covid, flu and, particularly in young children, Strep A and RSV. And just today the UK Health Security Agency has issued guidance encouraging people who feel unwell to stay at home, rather than mingling with others and risking spreading disease this festive season. Both COVID-19 and the flu are on the rise in the UK, with hospital admission rates from the former up to 9.56 per 100,000 people as of last week and 8.27 for the latter.

Medical microbiologist Professor Paul Hunter of the University of East Anglia told this year’s whammy of respiratory infections has a simple explanation.

He said: “It’s basically because we’ve not had much for the last few years — because of restrictions that have suppressed Covid, but have also suppressed a lot of other infections.

“We were expecting that when flu in particular came back that it would be a particularly bad flu year because we’ve not had any flu and therefore population immunity is lower.”

This, he explains, is essentially just a larger version of what is seen in isolated island communities that manage to avoid the flu for a few years before it returns.

He added: “When it does make it onto the island, they get it worse then.”

On top of the side-effects of COVID-19 restrictions, respiratory infections tend to be particularly challenging in winter for two reasons, Prof. Hunter explains.

He said: “One is that in winter, we’re just a bit more likely to be indoors in crowded environments than we are during the summer, during warmer months.”

“Some people have suggested that when it’s really cold out and we’re indoors in a warm environment, the air is quite dry — because the relative humidity is very low — and that dries the mucus in your nose, which protects against viruses.”

On top of this, he added, after a year one’s immunity to infection from many respiratory viruses is “well on the way to being gone” from the previous winter.

Prof. Hunter continued: “So, it sort of falls into this cycle where you’ve got a slightly greater risk of transmission during winter with the time that the immunity is waning from the previous year.”

When it comes to Group A Strep infections — which includes scarlet fever as well as the invasive form that has led to the death of a number of children in the UK in recent weeks — the picture is a little more complicated, Prof Hunter says.

As he explains: “When we see [cases of] invasive Group A Strep, they are usually secondary to a flu epidemic. When we’ve had bad scarlet fever years, they’re always years we’ve had bad flu.”

Strep A infections were prominent, he notes, back in the winters of 2017–18 and 2010–11, both of which were bad flu years, likely due to genetic changes in the virus.

Prof Hunter added: “The best thing you can do to protect your children from Group A Strep is to get them vaccinated against flu.”

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Professor Francois Balloux, a computational systems biologist with University College London, agrees that ensuring your flu vaccinations are up to date is a good step this year.

He said: “Flu vaccination obviously reduces the risk. This year, I’d like to say, the flu vaccine is really a good match.”

Looking further forward, Prof. Balloux noted there are also vaccines “on the horizon” for RSV — which he says has always been a “major problem” in very young children — and they look “pretty good”.

He added: “In the near future, I think pregnant women will be offered the vaccine — and it will produce antibodies that will be passed on to the baby.”

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