Worrying VICTORIAN return of DISEASES

Scarlet fever, TB, whooping cough, even scurvy. We thought they’d been consigned to history, but now worried doctors are asking ...

WHEn Joanna Birch-Phaure felt the beginnings of a sore throat, she was merely annoyed to have caught a bug just before going on holiday.

‘But I told myself the sunshine would make me feel better,’ says Joanna, 36, who lives in London with her husband Ashley, 34.

It didn’t — and within a few days of arriving in Tenerife with her friends in September 2013, the skin around Joanna’s feet had started to bubble and blister.

Once back in Britain, the rash spread dramatically all over her legs, stomach, arms, hands and face, leaving her skin feeling itchy and horribly dry.

Feeling ‘achey and fluey’, she saw her gP, whose diagnosis was far from what she had been expecting.

‘He took one look at me and told me I had scarlet fever,’ says Joanna, who works for development charity Pump Aid.

‘I was astonished — I thought the disease had been consigned to the history books.’

In fact, scarlet fever, the once feared Victorian disease that was a leading cause of infant death in the early 20th century, is making an alarming comeback. Its incidence has risen by 136 per cent in England over the past five years, and cases have reached a 50-year high with more than 17,000 confirmed last year, the highest since 1967.

This compares with only 1,678 cases in 2005. There is debate over whether the spike is simply due to the natural cycle of a virus or if other factors are to blame.

Analysis by Public Health England has found that every four years or so there is a higher than average year for scarlet fever — though this does not fully explain the extent of the current outbreak.

March and April are the peak time for scarlet fever, which is caused by bacteria known as group A streptococcus.

It’s characterised by sore throat, headache, fever and a red or pink sandpapery rash that appears within a day or two of the fever on the hands, chest and stomach before spreading. As contagious as flu, it’s passed on by coughing, sneezing, skin-to- skin contact and handling contaminated objects such as towels.

The bacteria are commonly found on the skin of healthy people — it is only when it gets into the body of someone with lower immunity that it causes scarlet fever.

Children under ten are most at risk, but as Joanna discovered, adults can get it, too.

She was given a course of antibiotics and told to rest and avoid others.

Unfortunately, her husband Ashley, a decorator, also came down with the bug a week later. ‘I’ve no idea where I caught scarlet fever from,’ says Joanna. It took her two weeks to feel back to her old self again.

‘I’m just grateful that modern medicine means it’s no longer fatal.’

Experts stress that the majority of scarlet fever cases clear up on their own and complications such as liver damage or pneumonia are rare, though it’s always recommended to see a gP if you think you or your child may have it.

But scarlet fever is not the only seemingly oldfashioned illness that’s back with a vengeance.

Since 2010, the number of people in the UK falling ill with whooping cough, cholera and scurvy has been rising steadily.

And tuberculosis, which killed off many Victorian heroines, novelists and poets, is making its way back up the disease rankings of today.

‘I think there is a general sense in this country that infectious diseases that were rife in the past have been completely eradicated,’ says John Oxford, emeritus professor of virology at Queen Mary, University of London.

‘ In fact, they have never been defeated, with the exception of smallpox. The rest could easily get a foothold again.’

He believes the rise in these diseases is caused by a ‘complex set of factors’, including poverty, population growth, scares over vaccines, poor hygiene and antibiotic resistance.

But if they get a foothold in vulnerable populations they can still spread to the general population.

‘Just because you’re affluent, you are not immune,’ says Professor Oxford.

‘Many of these infections are spread through the air and by touch, so you can pick them up going about everyday life in schools, hospitals and public transport.’

Measles and mumps, both highly contagious viral infections, have largely followed an upward trend since 2003.

There were 2,224 confirmed cases of mumps in 2014 in England, compared with 1,500 cases in 2003.

Measles rates rose dramatically from 400 confirmed cases in 2003 to 2,000 in 2012, though numbers dropped to just 91 cases in 2015, according to Department of Health figures.

‘ We do need to keep eternal vigilance,’ says Professor John Ashton, president of the Faculty of Public Health.

‘We don’t know where the next threat to our health is coming from.’

Here, experts explore why we are seeing a return of diseases that were thought to be a thing of the past.

ANTIBIOTICS MAY BE TO BLAME

ALOng with better sanitation, the advent of modern antibiotics in the Forties undoubtedly aided the decline of scarlet fever.

One theory as to why scarlet fever is on the rise again is that it’s an unforeseen consequence of doctors reducing antibiotic use in an attempt to curb antibiotic resistance.

‘Scarlet fever is caused by group A streptococcus, just like many common throat infections,’ says Professor Oxford.

‘The difference is that scarlet fever only occurs when the bacteria get further than the throat and manage to enter the bloodstream.’

Though he supports the reduction in antibiotic use, he adds: ‘It could be that widespread dosing of throat infections with antibiotics helped keep down scarlet fever, too, and now antibiotics are not given routinely, the illness is making a comeback.’

Another theory is that treating scarlet fever with antibiotics has led to resistant and aggressive strains developing, says Dr Adam Simon, a gP and chief medical officer at

pushdoctor.co.uk.

Researchers in the U.S. have linked the rise in scarlet fever to a resistant strain of bacteria.

However, an analysis of samples during the current UK outbreak found the strains are the same as in previous years.

ARE VACCINES GETTING WEAKER?

An OUTBREAK of the dangerous and highly contagious whooping cough in 2012 led to 9,000 cases in England — and 14 children dying.

Whooping cough (named after the ‘whooping’ noise that affects some as they gasp for breath after coughing fits), or pertussis, is a cyclical disease.

Cases were down again the following year, but health officials remain vigilant.

Children are protected by their routine vaccinations, and pregnant women are offered a vaccine, too. But researchers are investigating whether a change to the vaccine in 2004 to stop side-effects in sensitive people has made it less effective.

In 2014, an Oxford University study of 278 children who visited their gP with a persistent cough found that 18 per cent had evidence of a pertussis infection, despite having been vaccinated against it.

‘The vaccine was changed from a whole- cell vaccine, containing the entire inactivated pertussis bacteria, to acellular pertussis, meaning it contains only those parts of the bacteria needed to produce an immune response,’ says Richard Moxon, emeritus professor of paediatrics at the University of Oxford and founder of the Oxford Vaccine group.

‘This removed much of the material that caused reactions.

‘However, this also seems to have resulted in waning immunity. We are seeing a cohort of vaccinated

adolescents and adults who are still susceptible to picking up the bacteria and acting as carriers.

‘ They may only have mild symptoms, but can pass the bug on. Whooping cough is terrible in babies who have not yet had the vaccine.’ Older people who are not immune and have not been vaccinated are also at risk.

Despite the widespread use of the measles, mumps and rubella (MMR) vaccine, cases of mumps continue to be identified, mainly in people aged 15 to 30.

According to a report by Public Health England, more than 40 per cent of people infected with mumps in the first quarter of 2014 reported having had at least one dose of the MMR vaccination in childhood. Some cases in young adults may partly be down to waning immunity, the report said.

SCURVY’S SOARED 38pc SINCE 2010

THE rise in tuberculosis has been attributed to the increase in ethnic minority communities from countries where TB is more common.

In 2014, more than 6,500 cases of TB were reported in England — up from around 5,500 a year in the Nineties — and of these, around 4,700 were in people born outside the UK.

Some London boroughs have higher rates of TB than Rwanda, Iraq and Guatemala, a record fanned by mass migration and poverty, according to a recent report by the London Assembly Health Committee.

TB is a bacterial infection, usually spread through inhaling tiny droplets from the coughs and sneezes of other infected people.

It is more likely to spread through prolonged rather than one- off contact and often spreads among family members sharing a house.

Rising malnutrition may also be a factor in the increase of such diseases, says Professor Oxford. ‘Malnutrition can lead to weakening of the immune system, making people more at risk of infections.’

Very slow growing, TB is often halted in its tracks by the body’s immune system. Otherwise, it can usually be treated with antibacterial drugs, though resistance is becoming more of a problem.

‘You have to use a combination of different anti-tubercular drugs to tackle it effectively, but many people fail to keep up the course or drop one drug,’ says Professor Oxford. ‘This can lead to drug resistance.’

Doctors and researchers have also reported rises in diseases such as ringworm and scabies — also associated with poverty and overcrowding — in big cities across the UK.

And scurvy, caused by lack of vitamin C in the diet, has seen a rise of 38 per cent since 2010.

The rise in the incidence of cholera, caused by consuming contaminated food or water, which results in severe watery diarrhoea and can be fatal, is said to be due to travellers returning to the UK with the disease.

However, no cases of cholera have originated in England and Wales for more than 100 years.

VACCINE SCARES HELP DISEASE SPREAD

CHILDHOOD vaccination rates have been falling as anti-vaccine sentiment grows.

There are fears this trend may already be leading to outbreaks of conditions such as measles.

‘The drop-off in vaccine rates has caused damage to some children,’ says Professor Moxon.

‘By delaying or missing vaccines, children become more susceptible to infections and can pass them on to others.’

In 2014, a measles outbreak in Swansea saw 1,219 people infected, and last month doctors said there had been 20 cases in London and the South-East in February, which is unusually high.

Rife in the Victorian era, measles is one of the most contagious viruses on the planet, according to Professor Oxford — so much so that about 90 per cent of people who are not immune to it will become infected if they come close to an infected person.

However, it is entirely preventable if enough of the population adhere to vaccination programmes, says Professor Oxford. Controversy sparked by discredited British doctor Andrew Wakefield, who linked autism with the MMR vaccine, led to a drop-off in the number of children given the vaccine in the late Nineties.

At one stage, numbers dropped to around 80 per cent, well below the 95 per cent needed for ‘ herd immunity’ to be achieved.

In 2014- 15, MMR vaccination rates fell to just 87.3 per cent in

london and the proportion of two-year-olds having the jab fell across england for the first time in seven years.

There was a drop in vaccination rates for whooping cough in the Seventies and eighties, following a documentary linking the whooping cough vaccine to brain damage. This was followed by several large outbreaks.

Vaccination rates tend to be lower in more affluent areas — ‘boroughs in london such as Kensington and Chelsea still have the lowest uptake of childhood vaccinations,’ says Professor John Ashton.

But as he points out: ‘You should have your child vaccinated not only to protect them but also to protect everyone else’s child, too.’

MODERN LIVING IS GIVING US GOUT

iT MigHT sound archaic, but gout has become a modern complaint again. Hospital admissions for the condition have increased by 60 per cent between 2011 and 2015, from 65,387 to 104,972.

gout is a notoriously painful type of arthritis where crystals form within the joints. Though genes play a role, lifestyle is thought to be a factor, too.

The trend has been linked to alcohol consumption — alcohol increases levels of uric acid in the blood which form the crystals — and obesity.

Meanwhile, the Royal College of Paediatrics and Child Health is issuing guidelines to help gPs spot signs of bone-deforming disease rickets, such as poor growth, seizures and delayed walking.

Though numbers are still relatively small, hospital admissions have tripled in four years, to more than 4,500 children in 2013/2014.

Rickets is caused by a lack of vitamin d, the main source of which is sunlight. Many experts put the rise down to increased indoor living and changes to diet.

Additional reporting: ANgelA ePSTeIN.