Interim guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings
Best practice, Care guideline
Scarlet fever is a common childhood infection caused by Streptococcus pyogenes (also known as group A streptococcus [GAS]). These bacteria are found on the skin or in the throat, where they can live without causing problems. Under some circumstances GAS can cause non-invasive infections such as pharyngitis, impetigo and scarlet fever. On rare occasions they can cause severe disease, including streptococcal toxic shock syndrome, necrotising fasciitis, and invasive GAS (iGAS) infection. Scarlet fever was once a dangerous disease in the UK, but antibiotic treatment means it is now much less serious. Around 3-4,000 cases are diagnosed each year in England with 80% occurring in children under ten years old. It is most common in children between the ages of two and eight years, with four year olds most likely to develop the illness. Occasionally, outbreaks of scarlet fever occur in nurseries and schools. Routine national surveillance data for invasive and non-invasive GAS infections suggests a cyclical pattern with higher incidence peaks evident in notifications approximately every four years. Incidence of invasive disease tends to mirror that of superficial manifestations of GAS infection in many but not all years. As such, monitoring scarlet fever cases nationally can provide an early warning of increases in invasive disease. Seasonal trends show that increased levels of GAS infections typically occur between December and April, with peak incidence usually in March In England, statutory notifications of scarlet fever, based on clinical symptoms consistent with this diagnosis, are submitted to local health protection teams (HPTs). During periods of increased incidence, when there is sustained local transmission, HPTs may also see an escalation in reports of suspected cases and outbreaks from health professionals and from schools, nurseries and other child care settings. These guidelines were developed by the national Incident Management Team in response to the Level 3 scarlet fever incident in April 2014. They are interim guidelines based on a rapid review of the evidence and expert advice and they will be reviewed as new evidence emerges from the field. Once amended they are intended for routine use in the management of scarlet fever outbreaks. The aim of the guidelines is to support HPTs to control outbreaks of scarlet fever in schools, nurseries and child care settings and protect vulnerable children and adults.