Unusual number of scarlet fever cases in Great Britain

Cases of serious illness and death from streptococcal infections are increasing in the UK. Authorities are calling on parents to be vigilant.

Rashes after a streptococcal infection.

Phil Degginger / Keystone

The scarlet fever bacteria, so-called A streptococci, spread every year in the winter months where many people live close together, for example in schools, kindergartens or nursing homes. Scarlet fever is considered a classic childhood disease: It is the most common bacterial infection in children and adolescents. Since the development of penicillin in the middle of the 20th century, the highly contagious disease has largely lost its terror. Today, scarlet fever is usually mild. Serious complications only occur in rare cases.

In the UK, there has been a striking surge in Streptococcal infections this season. As the responsible health authority UK Health Security Agency announced, the number of scarlet fever cases is currently many times higher than usual at this time of year. According to the agency, 851 cases were detected in the third week of November; in previous years there had been an average of 186 cases in the corresponding week.

Of particular concern are six deaths in children under the age of ten in England and Wales – within seven days. Otherwise, one or two such deaths per winter are usual. The last time there was a significantly above-average number of serious diseases caused by group A streptococci was in winter 2017/18. At that time, four children in England died of complications in the same period.

Reasons are unclear

The reasons for the current accumulation are unclear. According to the British health authorities, there is no evidence of a more dangerous mutation in the bacteria. The increase is most likely related to high levels of circulating bacteria and social contact. British doctors believe it is possible that many children are less immune than in previous years due to the contact restrictions in the corona pandemic.

The British health authority calls on parents and doctors to be vigilant. Rapid reporting of cases, as well as laboratory tests and quarantine when the diagnosis is unclear, are necessary means to limit the spread of scarlet fever, the agency said.

It is not clear whether the scarlet fever cases are also increasing noticeably in Switzerland. Scarlet fever is not a reportable disease. The BAG was therefore unable to provide any information. There are also no official figures for the current situation in Germany.

How is scarlet fever transmitted?

Scarlet fever is highly contagious. In principle, anyone can get sick, but children of kindergarten and school age are most commonly affected. The Strep A bacterium is transmitted from person to person via saliva droplets that are spread when sneezing and coughing. Transmission can also occur through items such as shared dishes.

Every fifth to tenth person is a carrier of the scarlet fever pathogen, often without becoming ill themselves. Still, these people can pass the bacteria on to others. Outright epidemic outbreaks of scarlet fever are rare in Europe, however. However, they are more common in some countries with less developed basic medical care and corresponding hygiene standards.

What are the symptoms?

Usually two to five days elapse between the infection and the onset of the disease. The main symptoms are a sore throat and the typical – scarlet – skin rashes. Usually at the beginning there is a sore throat, difficulty swallowing, high fever, chills, malaise, as on a Information page of the German Robert Koch Institute is called. The tongue has a whitish coating and is covered with small, raised, bright red dots; In German this means «raspberry or strawberry tongue». In children, vomiting, headache, and abdominal pain are common. Between 2 and 48 hours after the onset of the fever, the typical red-spotted rash can appear, which begins on the upper body and then spreads to the groin and armpits. The rash disappears after six to nine days. Then the top layer of skin, especially hands and feet, peels off – similar to severe sunburn.

treatment and prevention

The disease is usually treated with antipyretic drugs and painkillers. According to the Zurich school health services used when symptoms worsen or do not improve after three days.

If scarlet fever is then treated with antibiotics, there is no longer any risk of infection 24 hours after the first intake, as is the case in Germany Federal Center for Health Education writes. Without antibiotic therapy, patients can remain contagious for up to three weeks after the first symptoms. The disease usually progresses without serious complications. Life-threatening courses with extremely high fever, clouding of consciousness, patchy skin bleeding, muscle cramps and drop in blood pressure are very rare. Two to three weeks after the symptoms have subsided, severe late complications with severe rheumatic fever and inflammation of several organs can occur in isolated cases.

The bacteria release toxins, so-called toxins. If a patient has survived the disease, he is protected from the respective toxin of the pathogen in the future. However, since the bacteria can form different toxins, it is quite possible to get scarlet fever several times.

There is no vaccination against type A streptococci. Important preventive measures are thorough, frequent hand washing, especially after contact with other people – for example during and after going to kindergarten or school.


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