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Increase in scarlet fever

Schools were contacted yesterday by about the recent national increase in notifications of scarlet fever to the UK Health Security Agency (UKHSA), above seasonal expected levels.

A joint letter from Alison Challenger, Director of Public Health and Paul Wagstaff, Director of Education, reminded them of the signs, symptoms, and the actions to be taken if they become aware of an outbreak at their school or nursery.

Signs and symptoms of scarlet fever

Scarlet fever is a common childhood infection caused by Streptococcus pyogenes, or group A Streptococcus (GAS). 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. Patients typically have flushed cheeks and pallor around the mouth. This may be accompanied by a ‘strawberry tongue’. As the child improves, peeling of the skin can occur.

Infection control advice in schools and nurseries

It is recognised that infections can be spread through direct physical contact between children and staff and through shared contact with surfaces such as tabletops, taps, toys, and handles. During periods of high incidence of scarlet fever, there may also be an increase in outbreaks in schools, nurseries, and other childcare settings.

As per national ‘Guidance on Infection Control in Schools and other Child Care Settings’, children and adults with suspected scarlet fever should be excluded from nursery / school / work for 24 hours after the commencement of appropriate antibiotic treatment. Good hygiene practice such as hand washing remains the most important step in preventing and controlling spread of infection.

Recommended actions if you suspect an outbreak at your school or nursery

  • Contact your Health Protection Team on 0344 225 3861 for advice or email: [email protected] for advice
  • Your Health Protection Team will provide you with a letter and Frequently Asked Questions to cascade to staff and parents if appropriate

Although scarlet fever is usually a mild illness, patients can develop complications and if you have any concerns please contact your local Health Protection Team for advice.


Scarlet fever: symptoms, diagnosis and treatment

Health protection in education and childcare settings

Hand hygiene resources for schools

Fact sheet for schools and parents about Group A Streptococcus (GAS)/ Scarlet Fever