Scarlet fever is a childhood illness that some might associate with the past, but it remains fairly common in the UK. In recent years, there has been a noticeable increase in cases. Here, we answer the most common questions about scarlet fever, what to look out for and how to reduce its spread.
What is scarlet fever?
Scarlet fever is an infectious disease caused by Streptococcus pyogenes bacteria, otherwise known as group A streptococci (GAS). The same bacteria can also cause illnesses such as strep throat and impetigo, or on rare occasions sepsis. Scarlet fever is defined by a characteristic rash, which develops as a reaction to toxins produced by the bacteria.
Thanks to antibiotics, scarlet fever is now usually a mild illness, but prompt treatment is important to reduce the risk of complications and prevent further spread.
Who gets scarlet fever?
Scarlet fever is mainly a childhood illness. Around 90% of cases occur in children under 10 years old, with the highest rates seen in children aged 2 to 8. Outbreaks can happen in nurseries and schools, where children are in close contact with each other.
Adults can also get scarlet fever, but this is much less common.
Is scarlet fever dangerous in pregnancy?
There is no evidence to suggest that having scarlet fever during pregnancy will harm your baby. However, scarlet fever can make you feel unwell, so it is best to avoid close contact with anyone who has the infection where possible.
If you are pregnant and develop symptoms of scarlet fever, you should contact your GP or NHS 111 promptly for advice. Many of the antibiotics used to treat scarlet fever are safe to take during pregnancy, and early treatment can help you recover more quickly and reduce the risk of complications.
What are the symptoms?
Symptoms often start with a sore throat, fever, headache, nausea and vomiting. After 12 to 48 hours, a distinctive rash usually appears.
The rash:
- feels rough, like sandpaper
- often starts on the chest or stomach before spreading
- may be harder to see on darker skin, but the sandpaper texture is still present
You can see pictures of the rash on the NHS page for scarlet fever
Other symptoms can include flushed cheeks, swollen glands in the neck and a white coating on the tongue that peels to reveal a red, swollen ‘strawberry tongue’. As the rash fades, the skin may peel, particularly on the fingertips and toes.
Can you have scarlet fever without a rash?
Technically, no. Scarlet fever is defined by the presence of the rash. Group A streptococcal throat infections would be diagnosed as ‘strep throat’ instead. These infections still need medical assessment and antibiotic treatment.
How does scarlet fever spread?
Scarlet fever is highly contagious. The bacteria spread through saliva and mucus, either by close contact with an infected person or via coughs and sneezes. It can also be picked up from contaminated surfaces or shared items such as cups, plates, toys or utensils.
People can pass the infection on before they show symptoms.
What should I do if I think my child has scarlet fever?
If you think you or your child might have scarlet fever, contact your GP practice or NHS 111 as soon as possible. Scarlet fever is usually diagnosed based on symptoms, although a throat swab may be needed.
Early treatment helps children recover more quickly and reduces the chance of serious complications.
How is scarlet fever treated?
Scarlet fever is treated with antibiotics, usually given as a 10-day course. Symptoms often improve within 24 hours, but it is essential to finish the full course to completely clear the bacteria and protect others.
Children and adults with scarlet fever should stay away from nursery, school or work until at least 24 hours after starting antibiotics.
Are there any complications?
Most people recover fully without any problems. However, without treatment, scarlet fever can occasionally lead to complications such as ear infections, sinusitis, throat abscess, cellulitis or pneumonia. More rarely, it can develop into invasive group A strep (iGAS), a serious condition that occurs when the bacteria spread deep into the body. Parents and carers should seek medical advice if symptoms worsen, do not improve, or if new symptoms appear in the weeks after recovery. Household contacts of scarlet fever cases are at risk of Group A Strep infections, particularly in the 2 to 3 weeks after the scarlet fever was diagnosed, and should seek medical advice if they become unwell.
How can I help prevent the spread?
Good hygiene plays a key role in stopping scarlet fever from spreading:
- wash hands frequently with soap and water
- open windows regularly to let in fresh air
- use tissues to catch coughs and sneezes and dispose of them promptly
- avoid sharing cutlery, cups, towels or bedding
- keep children at home for 24 hours after starting antibiotics
What is UKHSA’s role?
Scarlet fever is a notifiable disease in England and Wales, meaning suspected cases must be reported to local health protection teams. UKHSA monitors trends in scarlet fever and publishes regular updates on scarlet fever rates in England to help identify outbreaks early and protect communities.
Being aware of symptoms and acting quickly helps keep scarlet fever under control and protects those most at risk.
