Strep A: Manchester pharmacist discusses supply issues

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The various lockdowns of the last two years helped control the spread of COVID-19 — that was their intention. Yet, a byproduct of the isolation periods saw a drop in infections from other viruses, too. Things like Influenza (flu) and the common cold. Some scientists are now concluding that the public is suffering from an “immunity gap”, a decreased exposure to endemic viruses and so a lack of immunity protection. Cases of flu, respiratory syncytial virus, norovirus, strep A streptococcus (Strep A), and even COVID-19 are all on the rise. But why are some viruses spreading faster and more successfully than others? And is Britain — and possibly the world — really suffering from a so-called immunity gap? 

The world was warned

“The immunity gap” was described by Messacar and Baker in The Lancet medical journal as when susceptible individuals avoided infection, meaning they lack pathogen-specific immunity to protect against future infection. Although in the world of viruses, it’s up for debate. 

There has been a devastating surge in Strep A this year from which at least 19 children have tragically died in the UK. 

Group A Strep is a term for bacteria that often causes sore throats. However, some can suffer no symptoms at all. In some cases it can result in scarlet fever — which predominantly affects small children with approximately 90 percent of those ten and under developing the disease. In rare instances, it can lead to an invasive Group A Strep (iGAS) infection which would cause sepsis. 

Dr Nicole Robb, a virologist professor at the University of Warwick and the University of Oxford and co-founder of the health technology company, Picture, said there could be many reasons why we are seeing more cases of Strep A.

She told Express.co.uk: “For instance, people spend more time indoors during cold spells and the bacteria is spread through droplets, for example, coughing, sneezing and talking.

“It can also be that during the last three years we’ve had restrictions on socialising and that not only stops COVID-19 but other common respiratory illnesses like Strep. Measures that were put in place to slow the spread of COVID-19 also reduced the spread of other illnesses. 

“Because less people were infected than usual during this time, this has left a bigger pool of susceptible people after restrictions ended, which is sometimes referred to as ‘immunity debt’.”

Irregular exposure to common diseases do not make immune systems less effective, but that fall in immunity can result in a surge in illness as more people are there to be infected — something Dr Robb believes is playing a role in the winter surge. She added that although immunity debt may play a role in subsequent disease waves, it does not mean that protecting ourselves through lockdowns was a bad idea.  

Similarly, world-leading immunologist and co-founder of the COVID-19 screening service Cignpost, Professor Denis Kinane that it is difficult to say whether the spike is because of the “immunity gap”. He said: “It’s not a huge surprise, with experts warning about the phenomenon over a year ago.

“Prior to the pandemic, there was a predictable pattern to the outbreak of RSV and other seasonal respiratory viruses. However, due to the lockdowns over the last few years there’s not been as much mixing between individuals and households, so people have had less exposure to viruses and bacteria. As a result, some people’s immunity levels have dipped.”

If the recent spike in these infections is because of an immunity gap, this would, Prof Kinane said, not be expected to last in the long-term, as immunity builds back, and we regain our virus “resilience”. 

But many are unsure how they might go about doing so. Should they just let their bodies do the work? Are there supplements, foods to consume in order to help the fight back? 

“What we can be doing is strengthening our immune systems by addressing any vitamin or protein deficiencies,” said Prof Kinane. “While we bridge the immunity gap, supporting immune function will be important.”

While some of the figures surrounding the spikes in viruses are worrying —  scarlet fever cases have risen to 7,500 —  Dr Robb has said there is “nothing to say people should panic”, but stressed that parents should know the symptoms. 

She said that home testing, such as that seen for COVID-19, will help reduce transmission rates, as well as cutting down on giving out antibiotics “just in case”, which will in turn help prevent antibiotic resistance. 

Addressing worried parents, Dr Robb said: “With the current situation, if you suspect your child has a Strep A infection seek advice from a healthcare professional rather than trying to diagnose it yourself. A doctor will be able to use a variety of tests to confirm their diagnosis and will also be able to promptly prescribe antibiotics if needed. Early treatment of scarlet fever with antibiotics is important to reduce the risk of complications.”

Return of the Flu

While it is currently unclear whether an immunity gap might cause people to have more severe cases of these illnesses, Prof Kinane pointed out that immunocompromised individuals, as well as the eldest and youngest members of society, are most at risk of becoming ill more frequently. 

Interestingly, he added that unless the individual suffers from what has become known as long-COVID, there is “no evidence” that Coronavirus itself directly affects people’s immunity. 

According to the Weekly National Influenza and COVID-19 Report, published on December 15, the number of hospital admissions for positive Coronavirus cases peaked four times throughout the year and is now steadily increasing again with the highest rate among those aged 85 and over. 

Hospital admissions for influenza have similarly shot up in recent weeks, most dramatically among children up to four years old, and only slightly more amongst those aged 85 and over.

Between March 2020 and April 2021, 148,606 deaths had an underlying cause of COVID-19, compared to 35,007 from flu and pneumonia in the same period, ONS data shows. 

During the pandemic there was a sharp drop in flu cases, but now there are ten times as many patients with flu in hospital compared to December last year. Dr John McCauley, director of the Worldwide Influenza Centre, explained that measuring immunity is, however, difficult. 

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“For the population immunity itself to be reduced, it comes down to the individual, you can measure individuals from the population but you cannot measure population immunity,” he explained. “Flu was knocked down by all of these measures to stop Coronavirus as individuals were not exposed over the last two years. But now you have individuals who are not immune or immunity is waning.”

He explained that young children will have an absence of immunity with a larger number of children never having had flu, meaning they have a higher chance of catching and spreading it within that group as well as to those they interact with such as their parents. 

Between November 14 and 20 alone, estimates show that more than 200 children under five were hospitalised, suffering from complications caused by flu. Worryingly, the uptake of the flu vaccine among two and three year olds has “dropped considerably” in the last two years by more than ten percent. 

Dr McCauley continued: “Flu is going up exponentially. What usually happens is there’s a Christmas lull: schools stopping and people being too busy to go to the doctor. Frequently it zooms up just after Christmas and then later falls in January. That’s what we’ve seen in the last ten years.”

He explained that influenza activity looks similar to that seen in the 2019/2020 period before the pandemic, and that experts were not seeing viruses that would be able to bypass the current immunity vaccines. 

He added: “We haven’t seen anything that would make the flu vaccine worse than its usual performance. Circulation of flu has been hit in the last two years definitely, there could be more flu around now, but it doesn’t necessarily mean people are going to be worse off. More of it around will mean that it’s more important than ever to be vaccinated.”

So, can we bridge the immunity gap? 

The horrifying news of Strep A robbing children of their lives and cases of flu rising “exponentially” act as stark reminders that COVID-19 is not the only respiratory disease to worry about. 

Eating healthily, regularly exercise, and consuming sufficient amounts of vitamins have all been flagged by experts as ways of helping to keep a person’s immunity as strong as possible. 

For those who are eligible, getting a flu vaccine is strongly encouraged. New analysis from the Government has revealed that a nasal spray vaccine which helped protect children from flu could also help cut down the number of Strep A cases amongst children. 

“Prevention over cure” is the UK healthcare’s approach to healthcare with it being thought if the immunity gap is in fact the cause, immunity levels will soon be “bolstered”. 

“One thing for sure is that within the next few years, kids will have been exposed hence will have built up immunity,” Professor Kinane added. “I’d expect [prevention] to be driven further by the immunity gap, with health screenings playing a role to identify any other causes for reduced immunity and understanding the lifestyle choices we can be making to stay healthier for longer.”

Whether or not the resurgance of these diseases can be attributed to the immunity gap is too soon to say. Only time — and studies — will tell. 

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