PHE Update on rising Scarlet Fever across England

Group A streptococcus (GAS) on Blood Agar

Following the Public Health England (PHE) warning on the rise in cases of scarlet fever in England, they have reported a continued increase in cases of scarlet fever across England with 1319 new cases between 21 to 27 March. This is the highest weekly total recorded in recent decades (data available from 1982 onwards). Since the season began in September 2015, there have been a total of 10,570 reported cases of scarlet fever. Scarlet fever is a seasonal illness which should be treated with antibiotics and cases of the illness usually peak at this time of year.

An increase in invasive disease caused by the same bacterium Group A streptococcus (GAS) which causes scarlet fever has also been seen in England. A total of 593 cases of invasive Group A streptococcus infection, such and bloodstream infection or pneumonia, have been notified so far for 2016 compared to 440 cases for the same period last year (January to March). Group A streptococcus seasonal activity this year coincides with the seasonal influenza activity owing to the late flu season. Influenza and invasive Group A streptococcus co-infection is a rare but well-recognised occurrence. Whilst the elderly remain most at risk of invasive Group A streptococcus infection, increased levels of disease compared to last year have been seen in young adults and children less than 5 years old, the age groups most affected by influenza in recent weeks. There’s no suggestion of an increase in invasive Group A streptococcus infection in patients diagnosed with scarlet fever.

This is the third season in a row in which elevated scarlet fever activity has been noted. A total of 15,637 notifications were made in England and Wales in 2014, rising to 17,590 in 2015. Weekly activity so far this season has been similar or slightly above for that last year.

Group A streptococcus bacteria are spread by direct person-to-person contact with an individual carrying the bacteria or indirectly through contact with bacteria in the environment. The act of keeping wounds clean and practising hand hygiene can decrease chances of catching a Group A streptococcus infection.

Dr Theresa Lamagni, PHE’s head of streptococcal infection surveillance, said that while we hope that the Easter school break will assist in slowing down transmission of the bacteria causing scarlet fever, we cannot assume or rely on this being the case. As such, our investigations and assessment of the impact of this extraordinary rise in scarlet fever continue.

As we reach peak season for scarlet fever, health practitioners should be particular mindful of the current high levels of scarlet fever 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. PHE strongly urges people with symptoms of scarlet fever, which include a sore throat, headache and fever accompanied by a characteristic rash, to consult their GP. Scarlet fever should be treated with antibiotics to reduce risk of complications. Once children or adults are diagnosed with scarlet fever we strongly advise them to stay at home until at least 24 hours after the start of antibiotic treatment to avoid passing on the infection.

Scarlet fever is mainly a childhood disease and is most common between the ages of 2 and 8 years. It was once a very dangerous infection, but has now become much less serious, thanks to the use of antibiotics. There is currently no vaccine for scarlet fever.

Below is the PHE regional breakdowns for scarlet fever seasonal activity in England between September and March (for 2014 to 2015, and 2015 to 2016; weeks 37 to 13)

Scarlet Fever Notifications	2014 – 2015 (weeks 37 – 13	2015 – 2016 (weeks 37 - 13)
Area name	Total	Total
Anglia and Essex	458	689
Avon, Gloucestershire and Wiltshire	447	532
Cheshire and Merseyside	487	671
Cumbria and Lancashire	464	390
Devon, Cornwall and Somerset	262	365
East Midlands	1077	972
Greater Manchester	502	402
Kent Surrey and Sussex	680	814
London	876	1006
North East	536	667
South Midlands and Hertfordshire	386	502
Thames Valley	411	489
Wessex	587	711
West Midlands	766	999
Yorkshire and Humber	1440	1361
Grand Total	9379	10,570