As pupils and students return to school following the Christmas break, UKHSA is reminding people that winter illnesses continue to circulate at high levels.
Following simple steps can help protect children, minimise the spread of illness in education and childcare settings and protect wider communities.
Professor Susan Hopkins, Chief Medical Adviser at the UK Health Security Agency (UKHSA), said: “It’s important to minimise the spread of infection in schools and other education and childcare settings as much as possible. If your child is unwell and has a fever, they should stay home from school or nursery until they feel better and the fever has resolved.
“Helping children to learn about the importance of good hand hygiene is also key, so practice regular handwashing at home with soap and warm water. Catching coughs and sneezes in tissues then binning them is another simple way to help stop illness from spreading.
“Adults should also try to stay home when unwell and if you do have to go out, wear a face covering. When unwell don’t visit healthcare settings or visit vulnerable people unless urgent.
“Remember that flu vaccination is still available for all eligible groups and is the best protection against the virus. We have seen good uptake in older age groups but vaccination among young children remains low. Flu can be very unpleasant and in some cases can lead to more serious illness. Getting your child vaccinated protects them and others they come into contact with, and it’s still not too late.”
You may have seen in the news and online stories about Group A Strep.The latest data from the UK Health Security Agency (UKHSA) shows that scarlet fever cases continue to remain higher than we would typically see at this time of year.
Scarlet fever is a contagious infection that mostly affects young children. It’s easily treated with antibiotics.
The first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck).
Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash.
The illness is caused by Streptococcus pyogenes bacteria, also known as Group A Streptococcus, which are found on the skin and in the throat.
Generally, scarlet fever is much less common than it used to be but in recent years there have been a number of significant outbreaks.
This year we have seen higher than usual numbers of Group A Streptococcal (GAS) infections in Scotland and persistently high numbers of cases of scarlet fever among children.
It’s important to be aware of the signs and symptoms of scarlet fever so that early treatment with antibiotics can be given.
Scarlet fever symptoms
Scarlet fever usually follows a sore throat or a skin infection, like impetigo, caused by particular strains of Streptococcus bacteria.
The symptoms of scarlet fever usually develop 2 to 5 days after infection. However, the incubation period (the period between exposure to the infection and symptoms appearing) can be as short as one day or as long as 7 days.
Non-urgent advice:Speak to your GP if:
You or your child has symptoms of scarlet fever like:
a pinkish, rough textured rash
a sore throat
a headache
a high temperature (38.3C/101F or above)
flushed cheeks
a swollen tongue, known as strawberry tongue
Rash
The distinctive pink-red rash caused by scarlet fever develops 12 to 48 hours after symptoms like a sore throat or headache.
Red blotches are the first sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to touch and looks like sunburn. It may also be itchy.
On darker skin the rash may be more difficult to see although its rough texture should be apparent.
The rash usually starts on the chest and stomach, but soon spreads to other parts of the body, like the:
ears
neck
elbows
inner thighs
groin
The rash doesn’t usually spread to the face. However, the cheeks become flushed and the area just around the mouth stays quite pale. The rash will turn white if you press a glass on it.
The rash usually fades after about a week, but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards.
In milder cases, sometimes called scarlatina, the rash may be the only symptom.
red lines in the folds of the body, such as the armpit, which may last a couple of days after the rash has gone
a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue)
a general feeling of being unwell
When to seek medical advice
If you think you or your child may have scarlet fever, see your GP for a proper diagnosis and appropriate treatment. It usually clears up after about a week
Your GP should be able to diagnose scarlet fever by examining the distinctive rash and asking about other symptoms. They may also decide to take a sample of saliva from the back of the throat so it can be tested in a laboratory to confirm the diagnosis.
There’s no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk. However, if you’re heavily pregnant, tell the doctors and midwives in charge of your care if you’ve been in contact with someone who has scarlet fever.
How scarlet fever spreads
Scarlet fever is very infectious and can be caught by:
breathing in bacteria in airborne droplets from an infected person’s coughs and sneezes
touching the skin of a person with a Streptococcal skin infection, such as impetigo
sharing contaminated towels, baths, clothes or bed linen
It can also be caught from people who have the bacteria in their throat or on their skin but don’t have any symptoms.
Who’s affected by scarlet fever
Most cases of scarlet fever occur in children under 10 (usually between 2 and 8 years of age). However, people of any age can get the illness.
As it’s easily spread, scarlet fever is likely to affect someone in close contact with a person with a sore throat or skin infection caused by Streptococcus bacteria. Outbreaks can occur in nurseries and schools where children are in close contact with one another.
The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the Streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins.
It’s possible to have scarlet fever more than once, but this is rare.
Treating scarlet fever
Most cases of scarlet fever clear up after about a week without treatment. However, your GP may recommend treatment as it:
reduces the length of time you’re infectious
speeds up recovery
lowers the risk of complications of scarlet fever
With treatment, most people recover in about 4 to 5 days and can return to nursery, school or work 24 hours after starting antibiotic treatment.
Without treatment, you’ll be infectious for 1 to 2 weeks after symptoms appear.
Antibiotics
Scarlet fever is usually treated with a 10-day course of antibiotics. This is often in the form of penicillin or amoxicillin tablets, although liquid may be used for young children.
For people who are allergic to penicillin, alternative antibiotics like erythromycin can be used instead.
The symptoms usually improve within 24 hours of starting antibiotics, with the other symptoms disappearing within a few days. However, it’s important that the whole course of treatment is completed to ensure the infection is fully cleared and reduce the potential for antibiotic resistance.
Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment.
Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment.
Self care
Many of the symptoms of scarlet fever can be relieved using some simple self care measures.
Do
drink plenty of cool fluids
eat soft foods (if your throat is painful)
take paracetamol to bring down a high temperature
use calamine lotion or antihistamines to relieve itching
Complications of scarlet fever
Most cases of scarlet fever don’t cause complications, particularly if the condition is properly treated.
However, there’s a small risk of the infection spreading to other parts of the body and causing more serious infections, like:
If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment.
GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected.
Do
cover your mouth and nose with a tissue when coughing or sneezing
wash your hands with soap and water after using or disposing of tissues.
Don’t
do not share contaminated utensils, cups and glasses, clothes, baths, bed linen or towels
The latest data from the UK Health Security Agency (UKHSA) shows that scarlet fever cases continue to remain higher than we would typically see at this time of year.There were 851 cases reported in week 46, compared to an average of 186 for the preceding years.
Health officials have recorded more than 430 cases of Strep A in Scotland in two weeks.
Scarlet fever is usually a mild illness, but it is highly infectious. Therefore, look out for symptoms in your child, which include a sore throat, headache, and fever, along with a fine, pinkish or red body rash with a sandpapery feel. On darker skin, the rash can be more difficult to detect visually but will have a sandpapery feel. Contact NHS 111 or your GP if you suspect your child has scarlet fever, because early treatment of scarlet fever with antibiotics is important to reduce the risk of complications such as pneumonia or a bloodstream infection. If your child has scarlet fever, keep them at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.
Scarlet fever is caused by bacteria called group A streptococci. These bacteria also cause other respiratory and skin infections such as strep throat and impetigo.
In very rare occasions, the bacteria can get into the bloodstream and cause an illness called invasive Group A strep (iGAS). While still uncommon, there has been an increase in invasive Group A strep cases this year, particularly in children under 10.
There were 2.3 cases per 100,000 children aged 1 to 4 compared to an average of 0.5 in the pre-pandemic seasons (2017 to 2019) and 1.1 cases per 100,000 children aged 5 to 9 compared to the pre-pandemic average of 0.3 (2017 to 2019) at the same time of the year.
So far this season there have been 5 recorded deaths within 7 days of an iGAS diagnosis in children under 10 in England. During the last high season for Group A Strep infection (2017 to 2018) there were 4 deaths in children under 10 in the equivalent period.
Investigations are also underway following reports of an increase in lower respiratory tract Group A strep infections in children over the past few weeks, which have caused severe illness.
Currently, there is no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria and social mixing.
There are lots of viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell.
As a parent, if you feel that your child seems seriously unwell, 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 38°C, or is older than 3 months and has a temperature of 39°C 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
your child is floppy and will not wake up or stay awake
Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections.
Dr Colin Brown, Deputy Director, UKHSA, said: “We are seeing a higher number of cases of Group A strep this year than usual.
“The bacteria usually causes a mild infection producing sore throats or scarlet fever that can be easily treated with antibiotics.
“In very rare circumstances, this bacteria can get into the bloodstream and cause serious illness – called invasive Group A strep (iGAS). This is still uncommon; however, it is important that parents are on the lookout for symptoms and see a doctor as quickly as possible so that their child can be treated and we can stop the infection becoming serious.
“Make sure you talk to a health professional if your child is showing signs of deteriorating after a bout of scarlet fever, a sore throat, or a respiratory infection.”
