Table 2.

Summary of interim clinical guidelines released by UKHSA (UK Health Security Agency) on 09th December 2022 (valid till end of January 2023)

Key points from UKHSA interim clinical guidance (09.12.2022 – 31.01.2023)
Management of Possible Group A Streptococcus (GAS)	•Oral Phenoxymethylpenicillin is the first line of choice. •Amoxicillin, Macrolides and Cefalexin (in order of decreasing preference) can be considered as alternatives in case of non-availability of penicillin. •In case of non-severe penicillin allergy, Macrolides and Cefalexin are alternatives. •In case of severe penicillin allergy, Macrolides and Co-trimoxazole (SXT) are alternatives. •A 5-day course is enough for symptomatic cure. However, a longer 10-day course is needed for microbiological cure. The final decision of duration lies with treating clinician.
Management of Invasive Group A Streptococcus (iGAS)	•Maintain a low threshold for considering pulmonary complications of GAS. •Prompt initiation of appropriate antibiotics remains key. •Take a throat swab, blood cultures and other appropriate samples including respiratory culture, tissue, and fluid samples. •For culture-negative fluid specimens, it is advised to use PCR (GAS specific or 16S rDNA) for confirmation.
Notification of Cases (Epidemiology)	•Both GAS and iGAS are notifiable (both suspected and confirmed cases). • Definition for Severe GAS: a) Invasive disease defined through the isolation of GAS from a normally sterile site; b) GAS is isolated from a non-sterile site in combination with clinical signs consistent with a severe infection (streptococcal toxic shock syndrome, pneumonia, necrotising fasciitis, puerperal sepsis, meningitis, septic arthritis). •Diagnosis can be made using both culture and molecular methods.
Management of Contacts (Contact Tracing)	•Defined as prolonged contact with the case in a household-type setting during the 7 days before onset of symptoms and up to 24 hours after initiation of appropriate antimicrobial therapy in the index case. • Following individuals are required to undergo antibiotic prophylaxis following close contact: a) Pregnant women from ≥37 weeks gestation; b) Neonates and women within the first 28 days of delivery; c) Older household contacts (≥75 years); d) Individuals who develop chickenpox with active lesions either seven days prior to onset in the iGAS case or within 48 hours after the iGAS case commences antibiotics if exposure is ongoing.
Special Management in School or Early-year Settings	• Health Protection Teams or HPTs should be immediately contacted when schools experience any one of the following situations: a) one or more cases of chickenpox or Influenza in the class that has scarlet fever at the same time; b) outbreak of scarlet fever in a setting/class that provides care or education to children who are clinically vulnerable; c) outbreak continues for over 2 weeks, despite taking steps to control it; d) any child or staff member is admitted to hospital with any GAS infection (or there is a death); e) any issues that are making it difficult to manage the outbreak. •Further guidelines for schools is available from https://www.gov.uk/government/publications/scarlet-fever-managing-outbreaks-in-schools-and-nurseries (Accessed 10th December 2022).