Scarlet Fever and GAS Letter to Parents

8 Dec 2022

A letter from UK Health Security Agency and North Somerset Council:

Dear parents, guardians and carers,

Re: Increase in scarlet fever and Group A Streptococcal infections

We are writing to inform you of a recent national increase in notifications of scarlet fever to the UK Health Security Agency (UKHSA), above seasonal expected levels.

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 or your child 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, or your child, might have scarlet fever:

contact your GP or NHS 111 as soon as possible
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.

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 / 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.

Yours faithfully

Professor Dominic Mellon
MSc Dip HEP MEPS FRSPH FFPH Regional Deputy Director for South West UK Health Security Agency

Matt Lenny
Director of Public Health and Regulatory Services
North Somerset Council

Annex: Resources

NHS information on scarlet fever: https://www.nhs.uk/conditions/scarlet-fever/
UKHSA advice on the diagnosis and treatment of scarlet fever: https://www.gov.uk/government/publications/scarlet-fever-symptoms-diagnosis-treatment
UKHSA guidance on the management of scarlet fever outbreaks in schools: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1110540/Guidelines_for_the_public_health_management_of _scarlet_fever_outbreaks.pdf
UKHSA guidance on Health protection in education and childcare settings: https://www.gov.uk/government/publications/health-protection-in-schools-and- other-childcare-facilities/managing-specific-infectious-diseases-a-to-z
Additional resources to promote hand and respiratory hygiene in schools: http://www.e-bug.eu/