Antibiotics could be handed out in schools affected by Strep A outbreaks in the UK after a ninth child died.
The rare blanket treatment intervention comes after another three child deaths were confirmed in the past 24 hours due to the bacteria.
Penicillin, or another antibiotic like amoxicillin, could be administered to all children in a year group affected by a case of Strep A, a move contrary to the normal advice of doctors.
Schools minister Nick Gibb confirmed that the plan is an option.
"The UK Health and Security Agency are monitoring the position and are considering those kind of issues in those schools where there is an infection," he said on Tuesday.
"This is an ongoing situation. The UKHSA are involved very closely with those schools and they will be providing further advice later on.
"But that may well be an option for those particular schools where there is an infection."
The UKHSA said the measure of prescribing antibiotics to children in a school or nursery exposed to non-invasive Strep A was rare.
The agency added that the move was only considered in "exceptional circumstances" on a "case-by-case basis".
"In school and nursery settings, antibiotic chemoprophylaxis is not routinely recommended for contacts of non-invasive (Group A streptococcus) GAS infection," it said.
It comes after a ninth child, a five-year-old in Belfast, died.
That followed the announcement on Monday of two deaths — a pupil at Morelands Primary School, in Waterlooville, Hampshire and a Year Eight pupil at a secondary school in south-east London.
In addition, there are several cases of severe Strep A in Scotland, as well as a cluster of scarlet fever cases in Northern Ireland.
Adam Finn, professor of paediatrics at the University of Bristol and a consultant at the Bristol Royal Hospital for Children, said on Tuesday people are right to be worried and "it's an enormous tragedy for these families".
"We're not used, in our society, to losing the lives of previously healthy children — this is something that's very shocking and concerning," he said.
"What we've got to do is get the balance right here: on the one hand not alarm people whose children are mildly ill — and there are a lot of mildly-ill children around at the moment — and at the same time help people and support people to seek care and attention when their children become seriously ill, relentlessly sicker and sicker as the hours go by.
"Those are the children that need to be urgently seen."
He said children with "run of the mill" viral infections can feel unwell and then better again, and "things go up and down", and they continue to eat and drink.
"Children who've got invasive bacterial infection, they don't have those episodes of feeling better — they just get worse and worse," he said.
"They stop eating, they stop responding, they sleep a lot. They might complain, if they are awake, of aches and pains and headaches.
"They might have a rash or a sore throat or tummy ache, but they just get sicker and sicker.
"When you see that progressive decline, that's the time to get the child to medical attention."
Prof Finn said it is not yet known why the surge is occurring now.
“The honest truth is we don’t completely understand. But broadly, it is one of many infections we are seeing more cases of now because we were seeing less cases of it earlier in the year and last year when children were not interacting with each other so much,” he said.
“It may be directly because there was less Group A Strep around, so there is less immunity to that organism. But it is also quite likely to be related to all the viral infections we are currently seeing because viral infections do enable these bacteria to become more virulent.”
Standard guidelines suggest people wait for two cases in an institution before antibiotics were administered, he said.
“But given the number of cases and the concerns that obviously exist at the moment, those guidelines may well be adjusted and we may see more broad antibiotic use,” Prof Finn added.
“I think it will be done on a case-by-case basis. But we may see some antibiotics being given out to children who were in close contact with a case.”
However, some pharmacies are reporting a shortage in penicillin and amoxicillin due to the surge in cases.
The head of the Association of Independent Multiple Pharmacies, Leyla Hannbeck, tweeted that chemists were "reporting a shortage of amoxicillin liquid for children at a time when cases of Strep A are rising".
What is Strep A?
Strep A is a group of bacteria that can cause skin, soft tissue and respiratory tract infections, which are treated with antibiotics. Illness caused by the bacteria is usually mild, but infections can become serious and systemic.
Group A bacteria can colonise the throat, resulting in an infection called strep throat, which is painful and can create red spots in the area at the back of the roof of the mouth, and white patches or streaks of pus on the tonsils. Other symptoms include fever, a headache and a rash.
The bacterial infection can also result in another illness called scarlet fever, which begins with a high temperature, a sore throat and swollen glands.
A rash, which spreads and feels like sandpaper, appears 12 to 48 hours later on the chest and stomach. The tongue can also look bright red, like a strawberry.
Strep A can also cause a skin infection called impetigo, which begins with red, itchy sores that break open and leak pus for a few days before crusting over.
Any group A strep illness can result in invasive infections that spread into deep tissues and the bloodstream. Symptoms include fever and chills, muscle aches, nausea and vomiting, low blood pressure, a fast heart rate, rapid breathing and organ failure.
Streptococcal toxic shock syndrome, as it is known, is extremely serious and can kill.
Dr Susan Hopkins, chief adviser to the UK Health Security Agency, said on Monday said there were likely many factors causing the surge in cases.
“Firstly, I think that we’re seeing a lot of viral infections circulate at the moment and these bacterial infections can come as an addition on top,” she said.
“Secondly, we’re back to normal social mixing and the patterns of diseases that we are seeing in the last number of months are out of sync with the normal seasons as people mix back to normal and move around and pass infections on.”
She said the agency is exploring the fact there could be lower than normal immunity to the bacteria due to measures to combat the pandemic.
“We expect that a certain amount of children will have these infections each year and, therefore, they will have a level of immunity. So we’re seeing more now than we have seen for the last two years where there were very, very low amounts of infection seen,” she said.
