Latest data from the UK Health Security Agency (UKHSA) continues to show an out of season increase in scarlet fever and group A streptococcus infections.
So far this season (from 12 September to 11 December) there have been 7,750 notifications of scarlet fever. This compares to a total of 2,538 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018 there were 30,768 scarlet fever notifications overall across the year.
Invasive group A streptococcus (iGAS) infections remain rare. So far this season, there have been 111 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season* in 2017 to 2018.
There have been 74 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of cases continue to be in those over 15 years.
Sadly, so far this season there have been 74 deaths across all age groups in England.
This figure includes 16 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.
*We analyse scarlet fever seasons from week 37 to week 36 the following year. The majority of cases would typically be seen from the beginning of February to April.
Dr Colin Brown, Deputy Director, UKHSA, said:
Scarlet fever and ‘strep throat’ will make children feel unwell, but can be easily treated with antibiotics. Symptoms to look out for include fever, sore throat, swollen glands, difficulty swallowing, and headache.
Scarlet fever causes a sandpapery rash on the body and a swollen tongue. NHS services are under huge pressure this winter, but please visit NHS.UK, contact 111 online or your GP surgery if your child has symptoms of scarlet fever or ‘strep throat’ so they can be assessed for treatment.
At this time of year, there are lots of winter illnesses circulating that can make children unwell. Most of these can be managed at home and NHS.UK has information to help parents look after children with mild illness.
It is very rare that a child will go on to become more seriously ill, but parents know better than anyone else what your child is usually like, so you’ll know when they are not responding as they would normally.
Make sure you speak to a healthcare professional if your child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection – look out for signs such as a fever that won’t go down, dehydration, extreme tiredness, intense muscle pains, difficulty breathing or breathing very fast.
Good hand and respiratory hygiene are important for stopping the spread of many germs. By teaching your child how to wash their hands properly with soap for 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.
The first symptoms of scarlet fever include flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck).
A rash appears 12 to 48 hours later. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper.
On white skin the rash looks pink or red. On brown and black skin it might be harder to see a change in colour, but you can still feel the rash and see the raised bumps.
Contact 111 (online if child over 5) or GP surgery if your child has scarlet fever symptoms.
Symptoms can include nausea and vomiting.
The symptoms of ‘strep’ throat include:
- flu-like symptoms, such as a high temperature, swollen glands or an aching body
- sore throat
Contact 111 (online if child over 5) or GP surgery if your child has ‘strep’ throat symptoms.
The symptoms of iGAS include:
- high fever
- severe muscle aches
- localised muscle tenderness
- increasing pain, swelling and redness at site of wound
- unexplained diarrhoea or vomiting
There are several viruses circulating that cause sore throats, colds and coughs. These should resolve without needing medical attention. Antibiotics are not needed for viral infections. However, children can on occasion develop a bacterial infection at the same time as a virus and that can make them more unwell.
As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. Contact NHS 111 (online if child over 5) or your GP surgery 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 dehydration
- your baby is under 3 months and has a temperature of 38°C, or is 3 to 6 months and has a temperature of 39°C or higher
- your baby feels hotter than usual when you touch their back or chest, or feels sweaty
- 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
Cases of GAS usually increase during the winter and the last time significant numbers of cases were reported was in the 2017 to 2018 season. Seasons with high cases can occur every 3 to 4 years but social distancing measures implemented during the coronavirus (COVID-19) pandemic may have interrupted this cycle and may explain the current increase being observed.
While invasive group A strep is rare, close contacts of cases are at greater risk of developing the infection. Health protection teams follow national guidance to manage the contacts of iGAS cases and advise preventative treatment if necessary.
Following an evidence review of individuals who are at greater risk of invasive group A strep, UKHSA has updated guidance to expand the number of vulnerable groups who would be potentially eligible for prophylactic antibiotics following a risk assessment by health protection teams.
This evidence review was underway before the current rise in cases, and is now being implemented.
Data published by Public Health Wales and Public Health Scotland is also available.
Serious Shortage Protocols (SSPs) have been issued across the United Kingdom for three penicillin medicines today (Thursday 15th December).
SSPs are a standard procedure, used frequently to manage temporary and potential medicine supply issues. They are a safe and effective way to ensure that medicines continue to be available for everyone who needs them, while saving time for patients, pharmacists and prescribers.
Issuing an SSP allows pharmacists to legally supply a specified alternative medicine, removing the need for the patient to return to the prescriber – which saves time in GP practices and inconvenience for patients.
Usually when a patient presents a prescription, by law, the pharmacist can only supply what is on the prescription. If the medicine isn’t available, the patient must be sent back to the prescriber to get a new prescription for an alternative.
Demand for penicillin has risen recently as it is used to treat Strep A and Scarlet Fever, and the increased demand means that some pharmacists are experiencing temporary and localised supply issues and may not have the specific formulation listed on the prescription.
There are nine other SSPs currently active and have been used to improve patients’ access to Hormone Replacement Therapy drugs and were used extensively during the pandemic.
There are various versions of penicillin – liquid, sugar-free liquid, and tablet – and the SSP issued today will give pharmacists the flexibility to supply an alternative formulation, if they don’t have the one listed in stock.
The SSPs apply to the following medicines:
- Phenoxymethylpenicillin 250mg/5ml oral solution sugar free
- Phenoxymethylpenicillin 250mg/5ml oral solution
- Phenoxymethylpenicillin 125mg/5ml oral solution sugar free
Minister of State for Health Will Quince said:
The increased demand for the antibiotics prescribed to treat Strep A has meant some pharmacists have been unable to supply the medicine shown on the prescription.
These Serious Shortage Protocols will allow pharmacists to supply an alternative form of penicillin, which will make things easier for them, patients, and GPs.
We are taking decisive action to address these temporary issues and improve access to these medicines by continuing to work with manufacturers and wholesalers to speed up deliveries, bring forward stock they have to help ensure it gets to where it’s needed, and boost supply to meet demand as quickly as possible.
The Chief Pharmacist provided guidance to the profession last week, emphasising the importance of prescribers and local pharmacy teams working together to understand availability of antibiotics locally and ordering antibiotics sensibly, so not to put the supply chain under pressure.
The latest data from the UK Health Security Agency (UKHSA) shows there is an out of season increase in scarlet fever and Strep A infections. There is no evidence to suggest this is a new strain and it is likely being caused by high amounts of circulating bacteria and increased social mixing.
Strep A symptoms include flu-like symptoms, a sore throat, headache, fever, and muscle aches. If there is also a rash that feels rough like sandpaper it could be scarlet fever.
There are several viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention.
However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell.
For parents, if you feel that your child seems seriously unwell, you should trust your own judgement.
The NHS website has more information on the signs and symptoms of Strep A and Scarlet Fever.
Visit NHS.uk for more information.
Contains public sector information licensed under the Open Government Licence v3.0.
