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Researchers studying the winter 2022/2023 outbreak of group A streptococcus infections in Scotland have found strong evidence that the outbreak was not caused by a new virulent strain of the bacteria, but was likely the result of pandemic isolation precautions.

The study, published in the Journal of Infection and led by the University of Glasgow in collaboration with the Scottish Microbiology Reference Laboratory and Houston Methodist Hospital, suggests that the surge in strep A cases was due to lowered immunity levels as a result of less mixing and exposure to bacteria during lockdown precautions, not because a strain of the bacteria had become more dangerous.

Scotland, like many countries, saw a sharp rise in serious strep A infections in late 2022 and early 2023, when cases rose to four times their normal level in children, having fallen by about 70% during COVID-19 restrictions. The increase in infections led to a significant demand for antibiotics and primary care or hospital appointments.

While strep A infections usually cause sore throats and scarlet fever, the bacteria occasionally enter the blood, lungs or other parts of the body and cause life-threatening illness. The outbreak caused 28 child deaths across the U.K.'s four nations over a five-month period. Older adults were also significantly affected.

Scientists proposed three explanations: people had lower immunity after lockdowns, flu and other viruses were paving the way, or a new, more dangerous strain of the bacteria had appeared.

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