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Practice From Drug and Therapeutics Bulletin

Managing scarlet fever

BMJ 2018; 362 doi: (Published 30 August 2018) Cite this as: BMJ 2018;362:k3005
  1. Drug and Therapeutics Bulletin
  1. Drug and Therapeutics Bulletin Editorial Office, London WC1H 9JR, UK
  1. Correspondence to dtb{at}

What you need to know

  • Scarlet fever is usually a mild, self limiting illness, and has become more common

  • The typical rash is red, pin point, with a sandpaper texture, and spreads from the trunk and settles in the flexures

  • People can be infectious for two to three weeks after the symptoms appear, unless they are treated

  • Antibiotics minimise the risk of complications and onward transmission (typically non-infectious in 24 hours)

  • Rarely, invasive group A streptococcal infections such as meningitis, pneumonia, and septic arthritis develop

Scarlet fever is an infection caused by toxin producing strains of Streptococcus pyogenes (also known as group A streptococcus, or GAS). It was associated with high levels of morbidity and mortality when epidemics were common in the 18th and 19th centuries in Europe and the USA.1 Although the disease nearly disappeared during the 20th century, several countries, including the UK, have recently experienced a re-emergence of scarlet fever.123 In this article, we discuss the management of scarlet fever. In the UK, it is a notifiable disease.

How common is scarlet fever?

In England and Wales, the incidence of scarlet fever reduced from 250 notifications in 100 000 population per year in 1944 to less than 5 in 100 000 in the 2000s.3 In 2013-14, however, there were 25 notifications in 100 000.3 Around 87% of cases were in children under 10.2

In 2014, England experienced the highest number of scarlet fever cases in 45 years (table 1).4 In 2015 and 2016, scarlet fever notifications were elevated in all areas in England compared with the same period in the preceding year.56 In the 2016-17 season, weekly scarlet fever notification rates fell below those seen during the previous three seasons.7

View this table:
Table 1

Scarlet fever statistics (England)4

Peak season for GAS infections, including scarlet fever, occurs between December and April. …

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