Is Scarlet Fever Dangerous? What To Know As Cases Rise

Scarlet fever is on the rise again in the UK, with parents being urged to keep an eye out for symptoms in their children and seek treatment. 

Cases of the illness have surged by almost 70% in recent weeks – with almost 450 people infected in the week ending November 19, according to the Mirror.

But this is still lower than last year, when, in the week commencing November 28, there were 1,062 scarlet fever infection cases.

The condition, sometimes referred to as “scarlatina”, is a bacterial infection that most commonly affects children between the ages of two and eight.

Here’s what you need to know. 

What causes scarlet fever?

Scarlet fever is caused by the group A strain of the streptococcus bacteria. The infection enters the body through the throat, which is where symptoms begin.

NHS Choices states that generally, scarlet fever is much less common than it used to be, but in recent years there have been a number of significant outbreaks.

What are the symptoms?

Scarlet fever’s main symptoms include:

• a sore throat
• headache
• fever
• sandpapery, fine, pinkish or red rash
• flushed cheeks
• swollen tongue

The rash is likely to appear one or two days later than the sore throat and headache. It usually occurs on the chest and stomach before spreading to other areas of the body, such as the ears and neck.

The rash might also look different on darker skin. “On darker skin, the rash can be more difficult to detect visually but will have a sandpapery feel,” Duncan Reid, pharmacist at Pharmacy2Upreviously told HuffPost UK.

The British Islamic Medical Association explained that the rash can be more obvious in the groin and armpit area, and “sometimes the flushed cheeks appear as ‘sunburned’ on darker skin with whiteness near the mouth”.

“In children with darker skin tones, the rash could be harder to spot as it may not appear red, but will be darker than normal skin,“ Dr Mabs Chowdhury, president of the British Association of Dermatologists added.

“The rash in all pigment types can have a sandpapery feel. The tongue can appear redder than normal with prominent white spots (sometimes called ‘strawberry tongue’).”

How is it treated?

It’s important for parents to be aware of the symptoms and seek treatment quickly, as children will need to be given antibiotics.

The full course should be taken, even if your child starts to feel better quickly. 

Due to it being so contagious, if you or your child has the illness, you should stay at home for at least 24 hours after starting treatment with antibiotics.

Is scarlet fever dangerous?

In most cases, scarlet fever is mild. Dr David Cromie, a consultant in health protection at the Public Health Agency (PHA), told the Mirror: “Scarlet fever is contagious but not usually serious. Early treatment with antibiotics reduces the risk of complications and spread to others.”

In very rare cases though, children can develop invasive Group A Streptococcal disease (iGAS), which can be dangerous. Complications linked to iGAS include septic arthritis, pneumonia, meningitis, necrotising fasciitis and toxic shock syndrome. 

Last year, there were a string of deaths among children linked to iGAS. In December 2022, the UK Health Security Agency (UKHSA) confirmed 48 children under the age of 18 had died from it in England.

At the time, parents told HuffPost UK they were more concerned about the illness than they were when Covid-19 hit.

When to call a doctor

Usually scarlet fever clears up within a week, however if your child experiences any of the below symptoms, the NHS advises to call your GP or NHS111:

• your child is unwell and is getting worse
• your child is feeding or eating much less than normal
• your child has fewer wet nappies than usual or is peeing less than usual, or shows other signs of dehydration
• your baby is under 3 months and has a temperature of 38C, or is 3 to 6 months and has a temperature of 39C or higher
• your child is very tired or irritable.

When to go to A&E

If your child experiences any of the below symptoms, the NHS advises to call 999 or take them to A&E:

• difficulty breathing – they may make grunting noises, or you may notice their tummy sucking under their ribs
• pausing when breathing
• your child’s skin, tongue or lips are blue or grey – on black or brown skin this may be easier to see on the palms of the hands or soles of the feet
• your child is floppy and will not wake up or stay awake.

Scarlet fever and pregnancy

The NHS says there’s no evidence that getting scarlet fever during pregnancy can cause harm to the baby – but it can definitely make you feel unwell, so it’s best to avoid close contact with anyone who has it. 

If you’re heavily pregnant, tell the doctors and midwives in charge of your care if you’ve been in contact with someone who has scarlet fever. And if you suspect you’ve caught it, contact your GP who will prescribe antibiotics. 

Can you get scarlet fever twice?

Yes, it’s possible – although it’s pretty rare.

As NHS Inform explains: “The symptoms of scarlet fever will only develop in people susceptible to toxins produced by the Streptococcus bacteria. Most children over 10 years of age will have developed immunity to these toxins.”

How to prevent scarlet fever

As with anything, maintaining good hand hygiene and staying away from people who are sick is key. Pharmacist Duncan Reidpreviously told HuffPost UK: “Strep A is spread through contact with droplets from an infected person when they talk, cough or sneeze.

“Some people can have the bacteria present in their body without feeling unwell or showing any symptoms of infections and while they can pass it on, the risk of spread is much greater when a person is unwell. It is still possible to infect others for up to three weeks.”

He said good hand and respiratory hygiene are important to stop the spread of Strep A. It’s also important to avoid sharing cutlery, cups, towels, clothes, bedding or baths with anyone who has symptoms of scarlet fever.

“By teaching your child how to wash their hands properly with soap for at least 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections,” Reid said.