UKHSA update on scarlet fever and invasive Group A strep

The latest data from the UK Health Security Agency (UKHSA) continue to indicate that there is an out of season increase in Scarlet Fever and Group A Strep infections. Cases usually show steepest rises in the New Year, but have increased sharply in recent weeks.

So far this season (from 12 September to 4 December) there have been 6,601 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 2017/2018.

In very rare occasions, the bacteria causing Scarlet Fever, Group A streptococcus (GAS) can get into the bloodstream and cause an illness called invasive Group A strep (iGAS) which can be very serious, particularly in older, younger and more vulnerable groups. iGAS cases across all age groups are slightly higher than expected at this time of year. The latest data continue to highlight a higher proportion of iGAS cases in children than we would normally see. However, iGAS remains uncommon.

So far this season, there have been 85 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole of the last comparably high season in 2017/2018. There have been 60 cases in children aged 5 to 9 compared to 117 across the whole of the last comparably high season in 2017/2018. The majority of cases continue to be in those over 45.

Sadly, so far this season there have been 60 deaths across all age groups in England. This figure includes 13 children under 18. In the 2017/18 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Cases of GAS usually increase during the winter and the last time significant numbers of cases were reported was in the 2017/18 season. Seasons with high cases can occur every three to four years but social distancing measures implemented during the COVID-19 pandemic may have interrupted this cycle and explain the current increase being observed.

Currently, there is no evidence that a new strain of GAS is circulating or any increase in antibiotic resistance. Antibiotics are the best treatment and work well against the circulating strains. The increase is likely to reflect increased susceptibility to these infections in children due to low numbers of cases during the pandemic, along with current circulation of respiratory viruses, which may increase the chances of children becoming seriously unwell. However, investigations are underway to understand if there are other factors that could be contributing to the increase this season and to better understand who is currently most affected.

Dr Colin Brown, Deputy Director, UKHSA, said:

“Scarlet fever and ‘strep throat’ are common childhood illnesses that can be treated easily with antibiotics. Please visit NHS.uk, contact 111 online or your GP surgery if your child has symptoms of this infection so they can be assessed for treatment. Very rarely, the bacteria can get into the bloodstream and cause more serious illness called invasive Group A strep. We know that this is concerning for parents, but I want to stress that while we are seeing an increase in cases in children, this remains very uncommon. There a lots of winter bugs circulating that can make your child feel unwell, that mostly aren’t cause for alarm. However, make sure you talk to a health 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 and difficulty breathing.”

Good hand and respiratory hygiene are important for stopping the spread of many bugs. 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.

Please contact ukhsa-pressoffice@ukhsa.gov.uk with any queries.