Scarlet Fever on the rise in Midlands

Wednesday, 25th February 2015

FIGURES released by Public Health England say that in the Midlands, there have been more than double the number of cases of the illness in the first six weeks of 2015, compared to last year.

Healthcare staff have seen almost double the number of cases in the West Midlands this year, compared to 2014.  In the first 6 weeks of 2015 there were 118 confirmed cases, compared to 67 in 2014.

Scarlet fever is highly contagious and symptoms include a sore throat, a fever, and a fine, sandpapery rash. Children are more likely to catch the illness than adults, so nurseries and schools have been put on high alert.

The massive increase in the number of children diagnosed with scarlet fever this year has meant that parents are being warned to look out for symptoms of the contagious disease which claimed thousands of lives in the 19th century.

Dr Theresa Lamagni, PHE’s head of streptococcal infection surveillance, said: “As we enter into high season for scarlet fever, we ask GPs and other frontline medical staff to be mindful of the current high levels of scarlet fever activity when assessing patients.

“Prompt notification of cases to local health protection teams is critical to enable local monitoring and rapid response to outbreaks. Schools and nurseries should similarly be mindful of the current elevated levels of scarlet fever and promptly inform local health protection teams at an early stage if they become aware of cases, especially if more than 1 child is affected.”

Scarlet fever causes a sore throat, high temperature and a rash. It usually occurs in children. It has become much less common and less serious than it once was. Full recovery is usual. Treatment is with a course of an antibiotic. It is important to finish the full course of antibiotic, even if symptoms soon go, as this helps to prevent possible complications.

Scarlet fever is due to a throat infection caused by a bacterium (germ) called streptococcus. There are various strains (types) of streptococcus. They cause different infections and a strain called group A streptococcus causes scarlet fever.

The scarlet fever rash occurs when the streptococcal bacteria release toxins (poisons) that make the skin go red. The toxins get into the blood from the infected throat. Scarlet fever is most common in children aged 3-15 years, the most common age being 4 years. It more frequently occurs in the late winter or in early spring.

Scarlet fever rash

Scarlet fever rash

  • Sore throat and fever (high temperature) are the typical first symptoms.
  • A bright red (scarlet) rash then soon develops. The rash starts as small red spots, usually on the neck and upper chest. It may feel like fine sandpaper when you touch it. It soon spreads to many other parts of the body. The face may become quite flushed. The rash blanches (goes white) if you press on it. The areas of skin around the eyes, lips and nose are usually spared from this rash.
  • The tongue may become pale but coated with red spots (strawberry tongue). After a few days the whole tongue may look red.
  • Other common symptoms include: headaches, vomiting, being off food and feeling generally unwell.

The sore throat and fever last a few days, and then usually ease. The rash lasts about six days, and then usually fades away. As the rash fades, some of the skin may peel, mainly on the hands and feet (a bit like after being sunburnt). The rash can recur over the following three weeks though.

However, not all people with streptococcal infections develop the rash, as some people are not sensitive to the toxin. A mild form of scarlet fever may occur; this is often called scarletina.

th scarlet fever are advised to stay at home until at least 24 hours after the start of antibiotic treatment to avoid passing on the infection.

What is the treatment for scarlet fever?

Treatment is to speed recovery and to prevent possible complications.

A 10-day course of penicillin is usually advised. Other antibiotics are advised if you are allergic to penicillin. Symptoms usually improve in a few days, but it is important to finish the course of antibiotics. This makes sure all the bacteria are killed and reduces the chance of complications.

Make your child comfortable
A fever can make a child feel uncomfortable and irritable. The following are things that you can do that may bring the temperature down and make your child feel more comfortable:

  • You can give paracetamol or ibuprofen. Both of these medicines can lower a temperature. You can buy these medicines in liquid form for children. They come in various brand names. An alternative is to give soluble paracetamol in a drink. The dose for each age is given with the medicine packet. Note: these medicines do not treat the cause of the fever. They merely help to ease discomfort. You do not need to use these medicines if the child is comfortable and not distressed by the fever. Note: do not give both paracetamol and ibuprofen at the same time. However, on occasions, if a fever is difficult to control then, for each time a medicine dose is given, a doctor or nurse may advise alternating one of these medicines with the other. It is best only to do this alternating dose regime after assessment by a doctor or nurse.
  • Note: do not use ibuprofen for:
    • Children known to react (have hypersensitivity) to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
    • Children in whom attacks of asthma have been triggered by an NSAID.
    • Children with chickenpox. This is because some research has shown that ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) may increase the risk of developing serious skin infection complications in children with chickenpox.
  • Take the clothes off the child if the room is normal room temperature. It is wrong to wrap up a feverish child. The aim is to prevent overheating or shivering.
  • Give lots to drink. This helps to prevent dehydration. You might find that a child is more willing to have a good drink if they are not so irritable. So, if they are not keen to drink, it may help to give some paracetamol or ibuprofen first. Then, try them with drinks half an hour or so later when their temperature is likely to have come down. If breast-feeding then keep breast-feeding, as breast milk is the best fluid. However, you can offer feeds more often to increase the amount of fluid.

Do not cold-sponge a child who has a fever. This used to be popular, but it is now not advised. This is because the blood vessels under the skin become narrower (constrict) if the water is too cold. This reduces heat loss, and can trap heat in deeper parts of the body. The child may then get worse. Many children also find cold-sponging uncomfortable.

Some people use a fan to cool a child. Again, this may not be a good idea if the fanned air is too cold. However, a gentle flow of air in a room which is room temperature may be helpful. Perhaps just open the window, or use a fan on the other side of the room to keep the air circulating.