Scarlet Fever

Scarlet Fever and other Group A Streptococcus infections are circulating at high levels currently (Winter 2022-2023). The information below, provided by UKHSA, is designed to offer guidance and clarity as well as signposting further information if required.

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.  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. 

Children and adults with suspected scarlet fever should not attend nursery / school / work until 24 hours after the commencement of appropriate antibiotic treatment.

Contacts of Scarlet Fever cases (including siblings or household members) who are well and do not have symptoms do not require antibiotics and can continue to attend the setting.  They should seek treatment if they develop symptoms.

There is no increased risk of complications for pregnant women but if you are concerned, please discuss with your midwife.

Other Group A Streptococcus Infections

The same bacteria which cause scarlet fever can also cause a range of other types of infection such as skin infections (impetigo) and severe sore throat.  Detailed below are the actions that are relevant for these infections.

  • Impetigo:  This is a bacterial skin infection that mainly affects infants and young children.  It is very infectious, and the sores can develop anywhere on the body but tend to occur as reddish sores on the face, especially around the nose and mouth and on hands and feet. After about a week, the sores burst and leave golden brown crusts. It can sometimes be painful and itchy. 
    • Action:  Exclude the individual from the setting until all lesions (sores or blisters) are crusted over or until 48 hours after commencing antibiotic treatment.
  • Sore throats:  No specific actions required by the setting for other Group A Strep infections such as sore throats (and many sore throats are caused by viruses). 
    • Action:  If anyone is prescribed antibiotics for a sore throat, they should stay away from the setting for at least 24 hours after starting antibiotic treatment.

Invasive Group A Streptococcus (iGAS)

In very rare cases, the bacteria can get into the bloodstream and cause an illness called invasive Group A strep (iGAS). Whilst still 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. However, it is important that parents and carers understand the signs and symptoms of invasive disease and seek medical attention promptly. 

The following websites offer some further information and guidance.

NHS – Scarlet Fever

Scarlet fever: symptoms, diagnosis and treatment

ESCC Letter to Parents