New figures show at least 19 children have died across the UK from invasive streptococcal A disease.
The updated tally comes as the British government acknowledged supply problems with some of the drugs used to treat infections caused by the bacteria.
Latest data from the UK Health Security Agency shows 16 children have died in England since September.
The three other deaths were recorded in Belfast and Wales.
It is understood that health officials do not believe the number of scarlet fever infections has yet peaked, suggesting more deaths are likely.
Meanwhile, the government has introduced "Serious shortage protocols" for three types of oral solutions used in paediatrics — Phenoxymethylpenicillin, which is also known as penicillin V.
This means pharmacists can legally supply alternative forms of the medicine if they do not have the specific formulation stated on the prescription, such as an oral solution.
The protocols, which cover the entire UK, are intended to lessen the need for patients to return to their GP for a different prescription when they cannot get hold of a medicine.
Penicillin comes as liquid, sugar-free liquid and pills.
Health Minister Will Quince acknowledged that increased demand had left some pharmacists unable to meet prescriptions.
"These serious shortage protocols [SSPs] will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients, and GPs," he said.
Mr Quince said the situation was "temporary" and "localised" because of the high numbers of Strep A and scarlet fever cases.
The government was working with manufacturers and wholesalers to speed up supplies, he added.
The Health Ministry said SSPs were "standard procedure" and were used often "to manage temporary and potential medicine supply issues".
But pharmacists said they were “baffled” as to why it had taken so long for the government to introduce the protocols.
“This is a step in the right direction, and it will make the journey easier for patients and make it easier for pharmacists," Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, told BBC Radio 4.
“However, we’ve raised this concern about the shortage of antibiotics for many days now and we’re baffled by the fact that this has taken so long for things to move forward and for things to be planned accordingly.
“What happens now is the pharmacist will be able to prescribe an alternative antibiotic, according to the protocol.
“The supply of antibiotics generally at the moment is very patchy and it’s very difficult to get hold of them.
"As soon as something becomes available it just flies off the shelves because of the high demand.
“But this is certainly a step into in the right direction. However, this should have happened much earlier.”
What is strep A? - video
Group A strep bacteria can cause many different disorders, from minor illnesses to deadly diseases.
Illnesses caused by Strep A include the skin infection impetigo, scarlet fever and strep throat.
While the vast majority of infections are relatively mild, sometimes the bacteria cause a life-threatening illness called invasive Group A Streptococcal (iGas) disease.
The health agency has said there is no evidence that a new strain is circulating and the rise in cases is most likely caused by high amounts of circulating bacteria and increased social mixing.
It said that, since September, there have been 7,750 notifications of scarlet fever, more than three times the number in the last high season in 2017-2018.
There have been 111 iGas cases in children aged between one and four, and 74 cases in children aged five to nine.
Since September, 74 people of all ages have died in England.
“Scarlet fever and ‘strep throat’ will make children feel unwell but can be easily treated with antibiotics," said Dr Colin Brown, deputy director of the health agency.
“Symptoms to look out for include fever, sore throat, swollen glands, difficulty swallowing and headache.
“Scarlet fever causes a sandpapery rash on the body and a swollen tongue.
“NHS services are under huge pressure this winter, but please visit nhs.uk, contact 111 online or your GP surgery if your child has symptoms of scarlet fever or ‘strep throat’ so they can be assessed for treatment.”
Dr Brown said parents should also look out for signs that their child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection.
“Public Health Wales has confirmed it is investigating the deaths of two children as possible iGas cases,' a spokesman for the health authority in Wales said.
“Due to the risk of identification, Public Health Wales will not confirm numbers of deaths lower than five.”
But the families of Hanna Roap, 7, from Penarth in South Wales, and a child from Powys who has not been identified, have confirmed the cause of death of both children was iGas.
“The majority of those who become critically ill with iGas do so because of sepsis," said Ron Daniels, chief executive of the UK Sepsis Trust.
“This is why co-ordinated education and public messaging around both Group A Strep and sepsis symptoms is critical to ensuring people can be diagnosed and treated quickly and to prevent further lives lost."
Online health diagnoses - in pictures
Mr Quince explained why the protocols had been activated.
“The increased demand for the antibiotics prescribed to treat Strep A has meant some pharmacists have been unable to supply the medicine shown on the prescription," he said.
“These serious shortage protocols will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients and GPs.
“We are taking decisive action to address these temporary issues and improve access to these medicines by continuing to work with manufacturers and wholesalers to speed up deliveries, bring forward stock they have to help ensure it gets to where it’s needed, and boost supply to meet demand as quickly as possible.”
The Royal Pharmaceutical Society said pharmacists should be allowed to make minor changes to prescriptions without the need for a protocol.
“Ultimately we’d like to see a change in the law which makes the whole process of supply of medicines easier and quicker for both pharmacists and patients," said Thorrun Govind, chairman of the association in England.
"We urge the government to amend medicines legislation to allow pharmacists to make minor amendments to a prescription without any protocol being needed.
“At present a prescription can only be changed by the prescriber, which causes unnecessary workload for GPs and delays for patients.
“We want to see all pharmacists across the UK enabled to change prescriptions and be able to supply a different quantity, strength or formulation of a medicine — for example, changing capsules to tablets — on a daily basis, to avoid unnecessary bureaucracy and the need for an SSP to be developed, signed and authorised by a minister.
“In effect, it would mean that pharmacists can help patients straight away.”
Killing of Qassem Suleimani
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UK’s AI plan
- AI ambassadors such as MIT economist Simon Johnson, Monzo cofounder Tom Blomfield and Google DeepMind’s Raia Hadsell
- £10bn AI growth zone in South Wales to create 5,000 jobs
- £100m of government support for startups building AI hardware products
- £250m to train new AI models
Islamophobia definition
A widely accepted definition was made by the All Party Parliamentary Group on British Muslims in 2019: “Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslimness or perceived Muslimness.” It further defines it as “inciting hatred or violence against Muslims”.
Freezer tips
- Always make sure food is completely cool before freezing.
- If you’re cooking in large batches, divide into either family-sized or individual portions to freeze.
- Ensure the food is well wrapped in foil or cling film. Even better, store in fully sealable, labelled containers or zip-lock freezer bags.
- The easiest and safest way to defrost items such as the stews and sauces mentioned is to do so in the fridge for several hours or overnight.
The specs
- Engine: 3.9-litre twin-turbo V8
- Power: 640hp
- Torque: 760nm
- On sale: 2026
- Price: Not announced yet
Farasan Boat: 128km Away from Anchorage
Director: Mowaffaq Alobaid
Stars: Abdulaziz Almadhi, Mohammed Al Akkasi, Ali Al Suhaibani
Rating: 4/5
BlacKkKlansman
Director: Spike Lee
Starring: John David Washington; Adam Driver
Five stars
Who's who in Yemen conflict
Houthis: Iran-backed rebels who occupy Sanaa and run unrecognised government
Yemeni government: Exiled government in Aden led by eight-member Presidential Leadership Council
Southern Transitional Council: Faction in Yemeni government that seeks autonomy for the south
Habrish 'rebels': Tribal-backed forces feuding with STC over control of oil in government territory
INDIA SQUAD
Rohit Sharma (captain), Shikhar Dhawan (vice-captain), KL Rahul, Suresh Raina, Manish Pandey, Dinesh Karthik (wicketkeeper), Deepak Hooda, Washington Sundar, Yuzvendra Chahal, Axar Patel, Vijay Shankar, Shardul Thakur, Jaydev Unadkat, Mohammad Siraj and Rishabh Pant (wicketkeeper)
Benefits of first-time home buyers' scheme
- Priority access to new homes from participating developers
- Discounts on sales price of off-plan units
- Flexible payment plans from developers
- Mortgages with better interest rates, faster approval times and reduced fees
- DLD registration fee can be paid through banks or credit cards at zero interest rates
The specS: 2018 Toyota Camry
Price: base / as tested: Dh91,000 / Dh114,000
Engine: 3.5-litre V6
Gearbox: Eight-speed automatic
Power: 298hp @ 6,600rpm
Torque: 356Nm @ 4,700rpm
Fuel economy, combined: 7.0L / 100km
FULL%20FIGHT%20CARD
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Scores
Day 2
New Zealand 153 & 56-1
Pakistan 227
New Zealand trail by 18 runs with nine wickets remaining
Abaya trends
The utilitarian robe held dear by Arab women is undergoing a change that reveals it as an elegant and graceful garment available in a range of colours and fabrics, while retaining its traditional appeal.
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RESULTS
6.30pm Handicap (TB) US$65,000 (Dirt) 1,400m
Winner Golden Goal, Pat Dobbs (jockey), Doug Watson (trainer)
7.05pm Dubai Racing Club Classic Listed Handicap (TB) $88,000 (Turf) 2,410m
Winner: Walton Street, William Buick, Charlie Appleby.
7.40pm Dubai Stakes Group 3 (TB) $130,000 (D) 1,200m
Winner Switzerland, Tadhg O’Shea, Satish Seemar
8.15pm Singspiel Stakes Group 3 (TB) $163,000 (T) 1,800m
Winner Lord Giltters, Adrie de Vries, David O’Meara
8.50pm Al Maktoum Challenge Round-1 (TB) $228,000 (D) 1,600m
Winner Military Law, Antonio Fresu, Musabah Al Muhairi.
9.25pm Al Fahidi Fort Group 2 (TB) $163,000 (T) 1,400m
Winner Land Of Legends, Frankie Dettori, Saeed bin Suroor
10pm Dubai Dash Listed Handicap (TB) $88,000 (T) 1,000m
Winner Equilateral, Frankie Dettori, Charles Hills.
Electric scooters: some rules to remember
- Riders must be 14-years-old or over
- Wear a protective helmet
- Park the electric scooter in designated parking lots (if any)
- Do not leave electric scooter in locations that obstruct traffic or pedestrians
- Solo riders only, no passengers allowed
- Do not drive outside designated lanes
Our legal consultants
Name: Hassan Mohsen Elhais
Position: legal consultant with Al Rowaad Advocates and Legal Consultants.
Mercer, the investment consulting arm of US services company Marsh & McLennan, expects its wealth division to at least double its assets under management (AUM) in the Middle East as wealth in the region continues to grow despite economic headwinds, a company official said.
Mercer Wealth, which globally has $160 billion in AUM, plans to boost its AUM in the region to $2-$3bn in the next 2-3 years from the present $1bn, said Yasir AbuShaban, a Dubai-based principal with Mercer Wealth.
“Within the next two to three years, we are looking at reaching $2 to $3 billion as a conservative estimate and we do see an opportunity to do so,” said Mr AbuShaban.
Mercer does not directly make investments, but allocates clients’ money they have discretion to, to professional asset managers. They also provide advice to clients.
“We have buying power. We can negotiate on their (client’s) behalf with asset managers to provide them lower fees than they otherwise would have to get on their own,” he added.
Mercer Wealth’s clients include sovereign wealth funds, family offices, and insurance companies among others.
From its office in Dubai, Mercer also looks after Africa, India and Turkey, where they also see opportunity for growth.
Wealth creation in Middle East and Africa (MEA) grew 8.5 per cent to $8.1 trillion last year from $7.5tn in 2015, higher than last year’s global average of 6 per cent and the second-highest growth in a region after Asia-Pacific which grew 9.9 per cent, according to consultancy Boston Consulting Group (BCG). In the region, where wealth grew just 1.9 per cent in 2015 compared with 2014, a pickup in oil prices has helped in wealth generation.
BCG is forecasting MEA wealth will rise to $12tn by 2021, growing at an annual average of 8 per cent.
Drivers of wealth generation in the region will be split evenly between new wealth creation and growth of performance of existing assets, according to BCG.
Another general trend in the region is clients’ looking for a comprehensive approach to investing, according to Mr AbuShaban.
“Institutional investors or some of the families are seeing a slowdown in the available capital they have to invest and in that sense they are looking at optimizing the way they manage their portfolios and making sure they are not investing haphazardly and different parts of their investment are working together,” said Mr AbuShaban.
Some clients also have a higher appetite for risk, given the low interest-rate environment that does not provide enough yield for some institutional investors. These clients are keen to invest in illiquid assets, such as private equity and infrastructure.
“What we have seen is a desire for higher returns in what has been a low-return environment specifically in various fixed income or bonds,” he said.
“In this environment, we have seen a de facto increase in the risk that clients are taking in things like illiquid investments, private equity investments, infrastructure and private debt, those kind of investments were higher illiquidity results in incrementally higher returns.”
The Abu Dhabi Investment Authority, one of the largest sovereign wealth funds, said in its 2016 report that has gradually increased its exposure in direct private equity and private credit transactions, mainly in Asian markets and especially in China and India. The authority’s private equity department focused on structured equities owing to “their defensive characteristics.”
Sunday's fixtures
- Bournemouth v Southampton, 5.30pm
- Manchester City v West Ham United, 8pm
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Why it pays to compare
A comparison of sending Dh20,000 from the UAE using two different routes at the same time - the first direct from a UAE bank to a bank in Germany, and the second from the same UAE bank via an online platform to Germany - found key differences in cost and speed. The transfers were both initiated on January 30.
Route 1: bank transfer
The UAE bank charged Dh152.25 for the Dh20,000 transfer. On top of that, their exchange rate margin added a difference of around Dh415, compared with the mid-market rate.
Total cost: Dh567.25 - around 2.9 per cent of the total amount
Total received: €4,670.30
Route 2: online platform
The UAE bank’s charge for sending Dh20,000 to a UK dirham-denominated account was Dh2.10. The exchange rate margin cost was Dh60, plus a Dh12 fee.
Total cost: Dh74.10, around 0.4 per cent of the transaction
Total received: €4,756
The UAE bank transfer was far quicker – around two to three working days, while the online platform took around four to five days, but was considerably cheaper. In the online platform transfer, the funds were also exposed to currency risk during the period it took for them to arrive.
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