Increase in scarlet fever across England

PHE's latest data shows steep increases in scarlet fever notifications across England, as part of the peak season.

Public Health England (PHE) has reported steep increases in scarlet fever notifications across England, with a total of 6157 new cases since the season began in September 2015. This is the third season in a row where the incidence of scarlet has shown a marked elevation.

Around 600 cases are being notified each week at present with further increases expected as we reach the peak season, which typically occurs between late March and mid April.

All parts of the country have been affected by the increased numbers of scarlet fever cases seen over the past 3 years. Notifications of more severe infection caused by the same bacterium (group A streptococcus) are also showing a slight increase in incidence in recent weeks and will be monitored closely as the season progresses.

As a result of these increases, PHE is alerting health practitioners so they can be mindful of this when assessing patients. Close monitoring, rapid and decisive response to potential outbreaks and early treatment of scarlet fever with an appropriate antibiotic remains essential, especially given the potential complications associated with group A streptococcal infections.

Scarlet fever is an infectious disease spread through close contact with individuals carrying the organism (often in the throat) or indirect contact with objects and surfaces contaminated with the bacterium causing scarlet fever. Typically there are seasonal rises in scarlet fever between December and April each year.

In 2014, unusually high numbers of scarlet fever cases were noted, the highest since 1969, which persisted into the following year’s season and then into the current season. The reasons behind this increase are unclear but may reflect the long-term natural cycles in disease incidence seen in many types of infection. Assessment of bacteria obtained from patients has excluded the possibility of a newly emerging strain of group A streptococcus with increased ability to spread between patients causing the increase in disease incidence.

Dr Theresa Lamagni, PHE’s head of streptococcal infection surveillance, said:

"Parents can play a key role in recognising when their child needs to be seen by their GP.

"Early signs to look out for are sore throat, headache and fever with the characteristic pinkish/red sandpapery rash appearing within a day or two, typically on the chest and stomach but then spreading to other parts of the body. Individuals who think they or their child may have scarlet fever should seek advice from their GP without delay as prompt antibiotic treatment is needed.

"Symptoms usually clear up after a week and the majority of cases will resolve without complication as long as the recommended course of antibiotics is completed. Potential complications include include ear infection, throat abscess and pneumonia. Patients who do not show signs of improvement within a few days of starting treatment should seek urgent medical advice.

"As scarlet fever is highly contagious, children or adults diagnosed with scarlet fever are advised to stay off school or work until at least 24 hours after the start of antibiotic treatment to avoid passing on the infection.

"Where outbreaks occur, PHE local Health Protection Teams (HPTs) are on hand to provide a rapid response, effective outbreak management and authoritative advice. Schools, nurseries and childcare settings should embed good hand hygiene practice within daily routines for pupils and staff and alert their local PHE HPT if an outbreak of scarlet fever is suspected. Children and adults should be encouraged to cover their mouth and nose with a tissue when they cough and sneeze and to wash their hands after using or disposing of tissues."

Scarlet fever is mainly a childhood disease and is most common between the ages of two and eight years. It was once a very dangerous infection, but has now become much less serious. Antibiotic treatment should be given to minimise the risk of complications. There is currently no vaccine for scarlet fever.

See the latest health protection report and information on scarlet fever from PHE.

For further information for on scarlet fever visit the NHS Choices website.

Guidelines for the management of close community contacts of invasive GAS cases and the prevention and control of GAS transmission in acute healthcare and maternity settings are also available from the PHE website.