Every fall, thousands of children go back to school with new backpacks and high expectations. By Thanksgiving break, a substantial number of them will be complaining of sore throats, headaches and stomach pain. They'll run fevers, complain of swollen neck glands and have problems keeping their lunch down. In short, they'll have contracted strep throat, an infection caused by the group A streptococcus bacteria. Not all sore throats are "strep" throats---only about five to ten percent of sore throats are strep-related. And not all strep "presents," or shows up, as a sore throat. Some people carry the bacteria but never succumb to the infection it creates. Strep, however, is the most common bacterial infection in children between five and fifteen years of age. The reason for this is the way the infection spreads.
Group A streptococcus is contagious. The bacteria are carried by mucus and other bodily fluids. The key to strep's success in schools is that children wipe or touch their faces constantly. From one child's hands, the bacteria travel to books, pencils and classroom surfaces. Once another child borrows a pencil or touches a book or counter and raises his hand to his face, the cycle is complete and the bacteria have found a new host. Although the bacteria responds well to treatment with antibiotics like penicillin, most children do not complain of the illness until their throat closes up with soreness and swollen glands. This gives the germs a two-to-three day window to travel until the first child complains to a parent. By the time the parent gets the child in for a rapid antigen test for strep, the bacteria has traveled to a dozen other children who will spread it to a dozen more until the whole class, including the teacher, have been exposed. One of the main reasons children are admonished to wash their hands so often in school---and that sanitizing lotions are available when the class budget allows---is that children, unlike adults, don't think before they use their hands to wipe their eyes or pick their noses. They also engage in these behaviors much more frequently than adults.
Strep's prime season is late fall and early winter, when windows are closed up for the winter and air does not circulate freely. The children who pick up the strep bacteria at school will inevitably bring them home to share with their family. Antibiotics curb the contagious qualities of the bacteria within 48 hours, giving the germs two to five days, depending on how soon the infection is correctly diagnosed, to circulate at school and home. Considering the ease with which a strep infection can spread and the misery it causes, it's no wonder that many schools insist that strep throat be reported to the school and that children who are ill remain at home until the infection is under control. Parents can help by reinforcing hand-washing rules and keeping surfaces clean.