Increase in scarlet fever - advice for parents and carers

The latest data from the UK Health Security Agency (UKHSA) continues to indicate that there is an out of season increase in scarlet fever and group A strep infections.

While case numbers are high, parents and carers should be on the lookout for the symptoms of scarlet fever so that appropriate and timely treatment can be given.

Signs and symptoms of scarlet fever

Scarlet fever is usually a mild illness that clears up quickly after a course of antibiotics. It usually starts with a sore throat, headache, fever, nausea and vomiting, followed by a rash that feels like sandpaper to the touch.

The rash usually develops after 12 to 48 hours, typically on the chest and stomach first, then rapidly spreading to other parts of the body.

On white skin the rash looks pink or red. On brown and black skin it might be harder to see a change in colour, but you can still feel the sandpaper-like texture of the rash and see the raised bumps. Patients typically have flushed cheeks and can be pale around the mouth. This may be accompanied by a bright red ‘strawberry’ tongue.

Despite the increase we are seeing in scarlet fever and other Group A Strep infections, the risk of the bacteria causing a more serious infection remains very low. But as a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. If you think you, or your child, might have scarlet fever:

contact your GP or NHS 111 as soon as possible, because early treatment of scarlet fever with antibiotics is important to reduce the risk of a more serious infection
make sure that you or your child take(s) the full course of any antibiotics prescribed. Although you or your child will feel better soon after starting the course of antibiotics, you must complete the course to ensure that you do not carry the bacteria in your throat after you have recovered
stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection

You can help stop the spread of infection through frequent hand washing and by not sharing eating utensils, clothes, bedding and towels. All contaminated tissues should be disposed of immediately.

Contacts of scarlet fever cases (including siblings or household members) who are well and do not have symptoms do not require antibiotics and can attend school or work. They should seek treatment if they develop symptoms.

Invasive Group A Strep (iGAS)

The same bacteria which cause scarlet fever can also cause a range of other types of infection such as skin infections (impetigo) and sore throat. In very rare cases, the bacteria can get into the bloodstream and cause an illness called invasive group A strep (iGAS). Whilst still very uncommon, there has been an increase in iGAS cases this year, particularly in children under 10 years old. It is very rare for children with scarlet fever to develop iGAS infection.

As a parent, you should trust your own judgement.

Contact NHS 111 or your GP if:

your child is getting worse
your child is feeding or eating much less than normal
your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
your baby feels hotter than usual when you touch their back or chest, or feels sweaty
your child is very tired or irritable

Call 999 or go to A&E if:

your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
there are pauses when your child breathes
your child’s skin, tongue or lips are blue
your child is floppy and will not wake up or stay awake

Stop the spread

During periods of high incidence of scarlet fever, there may also be an increase in outbreaks in schools, nurseries and other childcare settings. Children and adults with suspected scarlet fever should stay off nursery, school and work until 24 hours after the start of appropriate antibiotic treatment.

Good hygiene practice such as hand washing remains the most important step in preventing and controlling spread of infection.

Local NHS information

NHS Sussex has issued advice to parents and carers who may be worried about the cases of ‘Strep A’ across the UK.

National information

The latest UKHSA updates for the public are available:

For members of the public seeking medical advice about group A streptococcal infections (also known as GAS, group A strep, strep A) please see the following advice: