The Rise of Scarlet Fever

In 2014 the number of people with scarlet fever in England more than tripled to over 14000. Previously about 4000 people would be diagnosed with it each year. 

Public Health England data show that increased levels of the scarlet fever infection are continuing.

What causes Scarlet Fever?

Scarlet fever is an infection caused by Group A Streptococcal bacteria. These bacteria usually live on the skin or in the throat. Up to 23% of healthy children will carry this bacteria on their skin without it causing any problems. Sometimes it can cause an infection which may lead to Scarlet fever and tends to start with a sore throat. The same bacteria can also cause impetigo, which causes a localised weeping skin infection.

Who does it affect?

Anyone can catch it, but mostly children between the ages of 2 and 10 are affected (about 90% of cases). The majority of people will have developed immunity by the age of 10. It rarely can be caught more than once.

How is it caught?

It tends to be more common in the winter and spring. Exposure to the infection normally occurs between 1 to 6 days before the symptoms appear.2 It is very contagious and can spread by coughing, sneezing, breathing out, or contact with an infected person's saliva through sharing utensils.

What symptoms to look out for

Scarlet fever usually starts with a fever, sore throat, flushed cheeks, swollen tongue and a headache.

Then a pink rash appears on the chest and abdomen which spreads, feels rough and may be itchy. The symptoms usually clear after a week. Peeling of the skin, in particular, the tips of the fingers or toes may occur when the rash has gone.

The rash and fever are caused by toxins produced by the bacteria.

How is it treated?

The diagnosis of scarlet fever is usually made from the symptoms alone.

Although scarlet fever is usually a mild illness that settles itself, prompt antibiotic treatment is needed to reduce the risk of spreading the infection and developing complications.

The first choice of treatment is phenoxymethylpenicillin unless the person has a penicillin allergy. The antibiotic must be taken for 10 days, but recovery is usually within 4-5 days. It is, however, important to complete the course of antibiotics to ensure the infection completely clears, even though the symptoms tend to settle before.

If antibiotics are not taken, then the person may be infectious for 2-3 weeks after the symptoms start.

Paracetamol or ibuprofen can be used to help control the fever.

How long to stay away from school?

Once the antibiotic is started, the person remains infective for up to 24 hours, so would need to avoid attending nursery, school or work for at least 24 hours after starting the antibiotic. This will help stop the spread of the infection to others.

How to prevent scarlet fever from spreading

Simple measures can help reduce the spread of scarlet fever. Since it is passed on through coughing, sneezing and saliva, children and adults should cover their mouth and nose with a tissue when they cough or sneeze. Also washing hands with soap and water after using or disposing of tissues will help.

Avoid sharing utensils, cups, clothes, baths, bedding or towels.

Are there any complications?

Complications are now rare particularly if treated with antibiotics, but there is a small risk of developing ear, throat, sinus and chest infections or meningitis.

On rare occasions, the later stages of the disease can result in bone, joint, liver, kidney problems or rheumatic fever.

Parents or patients should monitor for any symptoms that may suggest a complication has occurred, in the few weeks following the main infection. If any concerns then to seek medical advice straight away.

Scarlet fever and pregnancy

There's no evidence to suggest that catching scarlet fever when pregnant will put your baby at risk.2


  1. (Dec 2014) 'Scarlet fever: Guidance and data'.
  2. NICE CKS (Oct 2015) 'Scarlet Fever'.
  3. Public Health England: Bisno and Stevens (2010); Wong and Yuen (2012); PHE (2014b); PHE (2014c); Holden et al (2015).
Article written by
Disclaimer: This article is solely for information purposes. It is not to replace a consultation with a qualified health professional. It should not be used for the diagnosis or treatment of medical conditions. The article is based on the opinions of the author who retains copyright. You are advised to make your own health decisions based on your research and alongside a qualified health professional. Please consult a doctor if you have any health concerns.

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