In recent weeks, there has been an increased number of inpatococcal pharyngitis, mainly in school units in northern Greece and elsewhere in the country.

The Pan -Hellenic Federation of Freedom Profession of Pediatrics considers it necessary to clarify, with scientific precision and cool reason, the data on the transmission, prevention and management of incidents in a school environment.

Transmission of Streptococcus Group A

The Group A (Streptococcus Pyogenes) is mainly transmitted via droplets from the pharynx and the nasal cavity infected. Transmission is either by direct contact (eg sneezing, coughing, kisses), or by indirect contact, that is, through objects or surfaces that are infected with mucus or saliva.

Although microorganism does not survive for a long time in the environment, its survival on wet surfaces and objects (eg toys, pencils, desks) can take hours or even days, and can lead to secondary transmission, especially in synchronic and poor hygiene.

According to the guidelines of the European Center for Disease Control (ECDC, 2023) and the US CDC (2024), surface transmission is considered possible, but not the main dispersion mechanism. The main dispersion factor is the stay of children with school symptoms and close contact without complying with basic hygiene rules.

Cleaning and hygiene measures

No mass disinfection of schools with specialized workshops. However, increased care is recommended for the regular and diligent cleanliness of the often touched surfaces (such as desks, knobs, taps, toilets and toys). Cleaning with common detergents or household disinfectants is sufficient, since it is done daily, especially during periods of exacerbation.

Excessive use of disinfectants or “symbolic” disinfection, without at the same time preventive and information measures, does not provide a real benefit.

Closure of schools – when recommended

The closure of schools is not recommended as a general prevention measure. It can only be examined in cases of confirmed extensive dispersion, with a significant number of hospitalizations or serious cases, and exclusively after a documented suggestion by the health authorities.

Experience in managing epidemics in school units shows that shutdown, without combining outbreaks, updating, and hygiene rules, has a limited epidemiological value.

Recommendations to parents and schools

Children with symptoms such as fever, sore throat or rash should not come to school.

The pediatrician is responsible for the diagnosis and assessment of the need for treatment. The confirmation of streptococcal infection is done by a pediatrician’s rhythm test or a pharyngeal coating by the laboratory.

After the initiation of appropriate antibiotic treatment, the child ceases to be contagious within 24 hours and may return to school if it is in a good general condition.

School staff should remind and enhance the proper hand hygiene, respiratory hygiene (oral -nose coverage) and avoiding sharing of objects.

About the use of rush diagnostic tests (Strept-test)

Rapid strep tests should be performed exclusively in children with a clear clinical picture compatible with streptococcal pharyngitis. Proper interpretation of the results requires an appropriate clinical evaluation, as well as the correct pharyngeal coating technique, which is not possible outside the medical environment.

The use of these tests by parents at home or conducting them in pharmacies, without medical guidance, has a high risk of incorrect results and incorrect conclusions, especially when it comes to asymptomatic children. Their unjustified use, at the expense of concern or fear, does not contribute to public health and may lead to unnecessary treatments or complacency over real infection.

It is recommended for parents for greater safety for their children to be vigilant for the appearance of symptoms and to address the pediatrician in a timely manner for diagnosis and treatment where appropriate.