Scarlet fever: what you need to know

By William Flannery, ENT specialist at babylon

Public health monitoring

According to Public Health England, cases of scarlet fever in England have reached a 49 year high. 

In 2015 17,586 cases were reported, the highest number since 1967 when 19,305 cases occurred. This is a 236% increase since 2013 when just 4,642 cases were reported in total. The reason behind this is unclear, but it's likely that the increase reflects long-term natural cycles seen in many types of infection.

The good news is that the illness is short-lived and once you’ve had it, you’re immune.


What causes scarlet fever?

Scarlet fever is caused by a bacterium called Group A streptococcus. It mainly affects children under the age of 10 years, and it commonly affects children around 4 years old. Group A streptococcus causes sore throat, high temperature and a characteristic rash. Scarlet fever sometimes follows an outbreak of chicken pox.


The rash and other symptoms

The rash is caused by toxins released by the bacterium. It produces bright red spots on the neck and chest that spread to other parts of the body. Importantly, the rash of scarlet fever ‘blanches’ i.e. it becomes white when you press on it. The tongue is also affected, appearing pale with bright red spots – this is described as strawberry tongue.


There may be additional symptoms such as vomiting, headache, generally feeling unwell and being off food. The sore throat and fever last a few days, while the rash fades after 6. Sometimes this is accompanied by peeling and can look a bit like sunburn. In the following 3 to 4 weeks the rash can recur. Mild forms of scarlet fever are called scarletina.



Making the diagnosis

A diagnosis of scarlet fever is usually made clinically, based on the symptoms - our babylon doctors are available between 8am and 8pm Monday to Saturday and they are happy to consult with you. Sometimes a throat swab might be necessary to test for streptococcus in which case you will be asked to contact your family doctor. Treatment is usually with an antibiotic such as penicillin V or an alternative if your child has an allergy to penicillins.


Making your child comfortable

·      Remove bed covers and clothing to allow cooling from the fever

·      Use paracetamol in age-appropriate doses

·      Paracetamol can be used alternating with ibuprofen

·      Take care not to use a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, in children with NSAID triggered asthma, in aspirin sensitivity and chicken pox.

·      Encourage fluids

·      Do not cold sponge your child to reduce the temperature. This can cause changes in the blood flow to the skin, which leads to heat retention.


Look out for dehydration

A combination of vomiting, diarrhoea and sweating (from fever) can lead to dehydration. If this happens seek medical help. The signs of dehydration are dry mouth, no tears, sunken eyes, drowsiness and becoming increasingly unwell. It is important to encourage fluids from the onset of symptoms to avoid dehydration.


Keeping your child away from others

Scarlet fever is highly contagious. Following infection, symptoms take 2 to 3 days to develop. Your child should keep away from other children (except siblings) for at least 24 hours after antibiotics have been started. Once a child has had scarlet fever, he or she then has life-long immunity against the disease.