The UK Health Security Agency (UKHSA) has asked us to share information about a recent national increase in notifications of scarlet fever to above seasonal expected levels.

As part of our “Looking After Yourself this Winter” campaign, we would like to take this opportunity to remind you of the signs, symptoms and the actions to be taken if you think that you might have scarlet fever.

Signs and symptoms of scarlet fever

Scarlet fever is a common childhood infection caused by Streptococcus pyogenes, or group A Streptococcus (GAS). It is not usually serious, but should be treated with antibiotics to reduce the risk of complications (such as pneumonia) and spread to others. The early symptoms of scarlet fever include sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours, the characteristic red, pinhead rash develops, typically first appearing on the chest and stomach, then rapidly spreading to other parts of the body, and giving the skin a sandpaper-like texture. The scarlet rash may be harder to spot on darker skin, although the 'sandpaper' feel should be present. Patients typically have flushed cheeks and be pale around the mouth. This may be accompanied by a bright red ‘strawberry’ tongue.

If you think you might have scarlet fever:

• contact your GP or NHS 111 as soon as possible
• make sure that you take(s) the full course of any antibiotics if prescribed. Although you 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 college or work until 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 college/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.

Learners should trust your own judgement.

Contact NHS 111 or your GP if:

• you are getting worse
• you are eating much less than normal
• you are very tired or irritable

Call 999 or go to A&E if:

• you are having difficulty breathing
• there are pauses when you breathe
• your skin, tongue or lips are blue
• you are floppy and will not wake up or stay awake

Stop the spread

During periods of high numbers of scarlet fever, there may also be an increase in outbreaks in colleges, schools, nurseries and other childcare settings. The UK Health Security Agency (UKHSA) works in conjunction with these settings and you may receive further advice from the setting in the event of an outbreak.

Learners with suspected scarlet fever should stay off College 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.

Posted on behalf of the South East Region Health Protection Team

UK Health Security Agency

Resources and links

NHS – Scarlet Fever
Scarlet fever: symptoms, diagnosis and treatment
Hand hygiene resources for schools