There are currently high rates of Group A strep and scarlet fever in the UK. Scarlet fever, which is caused by the bacteria Group A streptococcus, is usually a mild illness but it is highly infectious.
It much more common in children than in adults; it is important that parents of children with suspected scarlet fever contact NHS 111 or their GP (doctor's surgery) as they may need antibiotics.
This is not only to reduce the chance of their infection becoming more severe but also to stop them spreading the infection to others, especially people at higher risk of severe infections such as the elderly and those with weakened immune systems.
Whilst severe complications of the infection are still uncommon, there has been an increase in cases this year, particularly in children under 10 and sadly, a small number of deaths.
What is Group A Streptococcus (GAS)?
Group A Streptococcus, shortened to GAS or group A strep, is a type of bacteria which can cause a wide range of infections like tonsillitis, scarlet fever, impetigo, or strep throat. GAS infections are common and, in most cases, mild. It is much more common in children than adults.
Very rarely, it can cause a more severe infection which is called invasive Group A Streptococcus, which is shortened to iGAS.
How does it spread?
When GAS bacteria are in the throat and on the skin of an infected person, the bacteria can spread through direct close or prolonged contact with an infected person. This is primarily through skin contact or sneezing from an infected person.
Whilst it is possible to encounter the bacteria on surfaces or objects touched by an infected person, the spread is likely to be limited through this route.
What is Scarlet Fever?
Scarlet fever is an infection caused by Group A Streptococcus bacteria.
Symptoms of scarlet fever:
- Sore throat
- Fever (temperature of 38C)
- Painful, swollen neck glands
- Red, rough rash that feels like sandpaper – this usually develops 12-48 hours after first symptom onset.
- Red tongue with a white coating (strawberry tongue)
Red, ‘sandpaper’ rash of scarlet fever. The rash might not look red on darker skin tones but will still feel rough to the touch.
If your child has symptoms of scarlet fever, you will need to see your GP as they may require antibiotics. Visit the NHS website for more information on how to manage scarlet fever at home.
When should I worry?
Seek urgent help if your child has any of the following:
- Is pale, mottled and feels abnormally cold to touch
- Has blue lips
- Too breathless to talk/eat or drink
- Has a fit/seizure
- Is extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Has dark green vomit
- Has a rash that does not disappear with pressure (the 'Glass Test')
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999
Contact NHS 111 or a healthcare professional if your child has any of the following:
- Is finding it hard to breathe
- Has laboured/rapid breathing or they are working hard to breathe – drawing in of the muscles below their lower ribs, at their neck or between their ribs (recession).
- Unable to swallow saliva
- Has features suggestive of scarlet fever (see above)
- Seems dehydrated (sunken eyes, drowsy or not passed urine for 12 hours)
- Is drowsy (excessively sleepy) or irritable (unable to settle them with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
- Has extreme shivering or complains of muscle pain
- Has a painful, red swollen gland in their neck which is increasing in size
- Is 3-6 months of age with a temperature of 39°C/102.2°F or above (but fever is common in babies up to two days after they receive vaccinations)
- Continues to have a fever of 38°C or above for more than 5 days
- If your child has recently had scarlet fever but now appears to have a puffy face/eyelids, tea or 'Coca-Cola' coloured urine (pee), or a swollen, painful joint(s)
- Is getting worse or if you are worried
You need to contact a doctor or nurse today.
If none of the above symptoms are present, continue with self-care.
Additional information is available about infant crying and how to cope - visit ICON for more details.
Children and young people who are unwell and have a high temperature should stay at home. They can go back to school, college or childcare when they no longer have a high temperature, and they are well enough to attend.
Other frequently asked questions
Please ring your GP surgery or call NHS 111
Watch Dr. Raj Singh talk about Step A and Scarlet Fever
Dr Ranj Singh explains what to look for:
There are a number of useful resources that provide more information on Strep A and Scarlet Fever