Increase in Scarlet Fever

E-mail from:
Fiona Johnstone
Director of Public Health
Head of Policy & Performance
Wallasey Town Hall
Brighton Street
Merseyside CH44 8ED

T: 0151 691 8152

25 April 2014

Dear Colleague

Increase in cases of scarlet fever

With reference to the above, you may be aware that nationally we have seen an increase, above seasonal expected levels in notifications of scarlet fever cases to Public Health England. In Wirral we have seen an increase in notifications from 11 during the first sixteen weeks in 2013 to 35 in the same period for 2014.

Whilst the increase in cases locally is not currently giving us cause of concern, I thought it would be prudent to take this opportunity to remind you of the signs, symptoms and the actions to be taken if you become aware of an outbreak at your school or nursery.

The definition of an outbreak is two or more cases of scarlet fever occurring within 10 days of each other from the same school or nursery. The scarlet fever diagnosis should be corroborated by a GP or other health professional before you contact the local Health Protection Team at Public Health England. We are not expecting you to contact GPs but rather would ask that you advise parents to seek medical advice from their GPs and report back to you. This is in order to distinguish scarlet fever from other viral infections with similar symptoms.

Signs and symptoms of scarlet fever

Scarlet fever is a common childhood infection caused by Streptococcus pyogenes, or group A streptococcus (GAS). The early symptoms of scarlet fever include sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours the characteristic red, pinhead rash develops, typically first appearing on the chest and stomach, then rapidly spreading to other parts of the body, and giving the skin a sandpaper-like texture. The scarlet rash may be harder to spot on the skin of some Black and Asian people, although the 'sandpaper' feel should be present. Patients typically have flushed cheeks and pallor around the mouth. This may be accompanied by a ‘strawberry tongue’. As the child improves peeling of the skin can occur.

Infection control advice

In schools and nurseries it is recognised that infections can be spread through direct physical contact between children and staff and through shared contact with surfaces such as table tops, taps, toys and handles. During periods of high incidence of scarlet fever there may also be an increase in outbreaks in schools, nurseries and other child care settings.

As per national Guidance on Infection Control in Schools and other Child Care Settings, children and adults with suspected scarlet fever should be excluded from nursery / school / work for 24 hours after the commencement of appropriate antibiotic treatment. Good hygiene practice such as hand washing remains the most important step in preventing and controlling spread of infection.

Recommended actions if you suspect an outbreak at your school or nursery:

• Contact the Cheshire and Merseyside Health Protection Team on 0844 225 1295 option 1 thrice for advice
• Your Health Protection Team will provide you with a letter to cascade to staff and parents if appropriate

Although scarlet fever is usually a mild illness, patients can develop complications and if you have any concerns please contact your local Health Protection Team for advice.

Thank you for your support.

Yours sincerely

Fiona Johnstone
Director of Public Health


1. Scarlet fever Q+A:
2. Guidance on infection control in schools and other childcare settings. Available here:
3. Hand hygiene resources for schools:

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