THE RED MENACE

As a new outbreak of the Victorian disease scarlet fever infects hundreds every week, our resident GP explains why it’s not just children who should beware...

A CHILD with a sore throat is something I see almost every day in surgery, especially as we approach spring – it’s a time when coughs and colds are rife.

But GPs are on high alert at the moment, looking out for this common ailment after warnings from Public Health England about the rise of scarlet fever. Since the start of the current school year in September, there have been more than 6,000 cases.

There have now been dramatic increases for three years in a row. Public Health England is being notified of about 600 cases a week – and this is expected to get worse as numbers usually peak in April.

But before you panic, let me say that such warnings are not uncommon – it’s the job of health officials to advise doctors and other care professionals about the threat of infections, whether that’s measles or something more sinister such as the Zika virus.

Usually the alerts reflect a growing global trend or a new illness. However, with scarlet fever, I have certainly diagnosed more cases in the past year, so I have witnessed at first hand a resurgence of what was considered an infection of the past.

QI thought scarlet fever was a Victorian illness. Why has it come back?

A The answer is not entirely clear. Scarlet fever is one of a number of diseases that were rife in the Victorian era, along with scurvy, cholera and whooping cough, that have increased since 2010.

But it is no longer the death sentence that it was in the pre-antibiotic era. Back then, scarlet fever could, and did, kill children quickly.

Investigations have been carried out to see whether the disease has mutated or become more virulent and therefore more easily spread, but this possibility has been ruled out.

Disease incidence does undergo natural long-term cycles, and the rise could simply reflect that.

Q What causes scarlet fever?

A It’s an infection caused by a bacterium called Group A Streptococcus, or Strep A. The bacteria is spread from close contact with those infected – through droplets in coughs and sneezes – but is also caught from contaminated objects and surfaces. Public Health England describes the infection as highly contagious.

Q Do people actually go scarlet?

A Scarlet fever causes a sore throat, fever and typical infection symptoms such as a headache and lethargy. Within two days of the illness starting, a rash develops which is pinky red – not usually as dramatic as scarlet – starting on the torso and the face and then spreading.

Usually the skin feels dry and papery, which makes this easy to differentiate from other types of rashes children may get with viruses. I’ve seen it described as ‘like goosebumps on sunburn’, which is pretty accurate.

Doctors also look for a ‘strawberry tongue’, where the tongue appears red and bumpy – another classic sign.

Typically, children aged between two and eight are susceptible. The disease can go on to cause more serious problems including ear infections, pneumonia and sepsis.

Q Is it just children who get it?

A According to reports, some cases are being seen in adults, but by far the highest proportion of cases occur in children between the ages of two and eight.

The streptococcus bacteria can cause illness in other age groups but not usually causing the rash symptoms of scarlet fever.

This is true of many bacteria which cause different illnesses in different age groups. One could hypothesise about the way the bacteria is treated by the immune system – the ‘scarlet’ part is caused by a toxin released by the bacteria, and adults may be less susceptible. But that doesn’t explain why younger toddlers don’t commonly get it either.

Q Is it easily treated?

A Scarlet fever is usually treated successfully with antibiotics. It is far less dangerous than it used to be, although complications such as pneumonia or sepsis do still happen.

It is important to start antibiotics quickly and remain at home for at least the first 24 hours of antibiotic treatment. The spread of infection is a problem as the condition is highly contagious, which is why staying at home is crucial. Outbreaks are already being reported in schools and nurseries: good hand hygiene is an essential part of controlling the spread.

Q The doctor always says that patients shouldn’t come in for a sore throat and that we can’t have antibiotics. How do I know when to go to the GP?

A It is difficult to get the right balance as most people with a sore throat will not have scarlet fever.

On the other hand, prompt treatment of the disease is key for the individual patient and also to fight the spread of infection.

As we have an outbreak of scarlet fever currently, it is sensible for parents to at least talk to the GP if their child has a sore throat with a fever. If a rash develops, seeing a doctor the same day is important. We are trying to reduce unnecessary prescriptions of antibiotics, but with clear clinical features, using these drugs to tackle scarlet fever is appropriate.