Scarlet fever

Scarlet fever

What is scarlet fever?

Scarlet fever is a common childhood infection caused by Streptococcus pyogenes (also known as group A Streptococcus [GAS]). These bacteria may be found on the skin, throat and other sites where they can live without causing problems. Under some circumstances GAS can cause non-invasive infections such as pharyngitis, impetigo and scarlet fever. On rare occasions they can cause severe disease, including streptococcal toxic shock syndrome, necrotising fasciitis, and septicaemia.

Scarlet fever was once a very common and dangerous disease in the UK, but antibiotic treatment means it is now much less serious.

The local incidence of based on statutory notifications to the Public Health Agency is shown below - 

The number of cases of scarlet fever reported to the PHA in the first three months of 2018 has increased compared with the same period in the past two years. However cases are not predicted to be as high as those seen in 2014. It’s not uncommon to see a rise in cases of scarlet fever at this time of year. Scarlet fever is not usually a serious illness and can be treated with antibiotics to reduce the risk of complications and spread to others.

Scarlet fever symptoms

The symptoms of scarlet fever are non-specific in early illness and may include sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours the characteristic red, generalised pinhead rash develops, typically first appearing on the chest and stomach, rapidly spreading to other parts of the body, giving the skin a sandpaper-like texture. On more darkly-pigmented skin, the scarlet rash may be harder to spot, although the “sandpaper” feel should be present. Patients typically have flushed cheeks and paleness around the mouth. This may be accompanied by a ‘strawberry tongue’. During convalescence peeling of the skin may occur at the tips of fingers and toes and less often over wide areas of the trunk and limbs.

Although scarlet fever is usually a mild illness, some patients may require hospital admission to manage symptoms or complications. These include ear infection, throat abscess (quinsy), pneumonia, sinusitis or meningitis. Whilst such complications arise in the early stages, sequelae including acute glomerulonephritis and acute rheumatic fever can arise at a later stage. Prompt treatment with appropriate antibiotics significantly reduces the risk of complications. Clinicians should advise patients, or their parents/guardians, to keep an eye out for any symptoms which might suggest these complications and to seek medical help immediately if concerned.

Parents should contact their GP if they spot symptoms of scarlet fever or have concerns. Children or adults diagnosed with scarlet fever are advised to stay at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.

Medical Practitioners should notify cases of Scarlet fever to the Public Health Agency to allow identification of clusters or outbreaks and enable any further public health action.

For further information see: