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December 2017

Resurgence of scarlet fever across England

Cases of scarlet fever reached a 50-year high in England in 2016, after decades of declining incidence. The number of new cases to be notified has increased seven-fold in the last 5 years (2011-2016), according to research published in The Lancet Infectious Diseases journal.

A total of 620 outbreaks (over 19,000 cases) of this highly contagious bacterial illness were reported in 2016, mostly in schools and nurseries. The population rate in 2016 was 33.2 cases per 100,000.

While not usually serious, patients need antibiotic treatment to reduce the risk of complications, and to reduce the likelihood of contagion. Around 1 in 40 cases are admitted to hospital, although just over half are discharged the same day. Symptoms include a sore throat, headache and fever accompanied by a characteristic pink-red rash that feels like sandpaper. Most cases occur in children under 10 although individuals of any age can develop the condition.

The reason for this ongoing rise in cases remains unidentified. Molecular genetic testing has ruled out a newly emerged strain of the infection, and research is underway to understand the possible cause and assess prevention strategies.

‘While current rates are nowhere near those seen in the early 1900s, the magnitude of the recent upsurge is greater than any documented in the last century,’ says Dr Theresa Lamagni, Head of Streptococcal Surveillance at Public Health England, London, UK who led the study. ‘While notifications so far for 2017 suggest a slight decrease in numbers, we continue to monitor the situation carefully. Guidance on management of outbreaks in schools and nurseries has just been updated and research continues to further investigate the rise.’

General practice nurses providing travel health services need to be aware that several countries in East Asia have also reported an escalation, including Vietnam, China, South Korea, and Hong Kong.