ENT  |  Sore Throat Pathway - Isolate for 24 hours if at increased risk of spreading GAS


Sore Throat Pathway - Isolate for 24 hours if at increased risk of spreading GAS

Those at increased risk of spreading GAS i.e. healthcare workers, food handlers (i.e. any person who comes into direct contact with food or the equipment or utensils used to prepare food e.g. cooks, waiting staff etc), teachers, early childhood educators and pupils should be isolated for 24 hours post starting antibiotics.

Reference: New Zealand Guidelines for Rheumatic Fever; 2014 Update; pg 42-43.

Who is at increased risk of spreading GAS?

Group A streptococcus is spread through droplets of saliva or nasal secretions, as well as in water and food preparation. Nasal GAS infection has also been implicated by Hamburger et al(1945) and Jarrett et al (1950).

GAS spread has been demonstrated to occur in a variety of settings, including households, military barracks, classrooms, day care, hospitals, and residential care. A GAS outbreak in Christchurch in 2014 in an aged care facility led to five deaths.

Those at increased risk of spreading GAS include:

  • Healthcare and residential care workers (Pichichero & Casey 2007A, 4 expert opinion).
  • Food handlers (Darrow 2002, NZ Government 2013).
  • Teachers (expert opinion, NZ Government 2013).
  • Childcare workers (expert opinion).

Adults presenting with symptomatic pharyngitis who have otherwise been assessed as being low risk for ARF, should be assessed, based on their employment, for their risk for spreading GAS in the workplace to those at high risk for ARF. If they are assessed as being at increased risk of spreading GAS, it is recommended that a throat swab be taken for culture and if GAS positive, they should be treated with appropriate antibiotics. In addition, the Health (infectious and Notifiable Diseases) Regulations allow for seven days exclusion from work or school to be enforced for teachers and students with GAS pharyngitis. As stated earlier, this legislation is rarely invoked.

Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

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