Dear Parent(s) / Carer(s),

Re: Increase in scarlet fever

We are writing to inform you of a recent increase in notifications of scarlet fever to
the UK Health Security Agency (UKHSA), above seasonal expected levels.
We would like to take this opportunity to remind you of the signs, symptoms and the
actions to be taken if you think that you or your child might have scarlet fever.
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 to reduce the risk of complications (such as pneumonia) and spread to
others. The early symptoms of scarlet fever include sore throat, headache, fever,
nausea and vomiting. After 12 to 48 hours, the characteristic red rash develops,
usually first on the chest and stomach, then rapidly spreading to other parts of the
body, making the skin have a sand-paper like feel to it. The scarlet rash may be
harder to spot on darker skin, although the ‘sandpaper’ feel should be present.
Patients usually have flushed red cheeks. They may also have a bright red
‘strawberry’ tongue.

If you think you, or your child, might have scarlet fever:
• contact your GP or NHS 111 as soon as possible
• make sure that you or your child take(s) the full course of any antibiotics
prescribed. Although you or your child will feel better soon after starting the
course of antibiotics, you must complete the course to ensure that you do not
carry the bacteria in your throat after you have recovered
• stay at home, away from nursery, school or work for at least 24 hours after
starting the antibiotic treatment, to avoid spreading the infection
You can help stop the spread of infection through frequent hand washing and by not
sharing eating utensils, clothes, bedding and towels. All contaminated tissues
should be disposed of immediately.

Invasive Group A Strep (iGAS)

The same bacteria which cause scarlet fever can also cause a range of other types
of infection such as skin infections (impetigo) and sore throat. In very rare cases, the
bacteria can get into the bloodstream and cause an illness called invasive group A
strep (iGAS). Whilst still very 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.

As a parent, 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
• your baby is under 3 months and has a temperature of 38C, or is older than 3
months and has a temperature of 39C or higher
• your baby feels hotter than usual when you touch their back or chest, or feels
• 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
• there are pauses when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake

Stop the spread

During periods of high incidence of scarlet fever, there may also be an increase in
outbreaks in schools, nurseries and other childcare settings. Children and adults with
suspected scarlet fever should stay off nursery / school / work until 24 hours after
the start of appropriate antibiotic treatment. Good hygiene practice such as hand
washing remains the most important step in preventing and controlling spread of
Yours sincerely,
Greg Fell
Director of Public Health, Sheffield

Nachi Arunachalam
Consultant in Communicable Disease Control, Yorkshire and Humber – Sheffield

UK Health Security Agency letter