Group A Strep and scarlet fever during a time of winter pressures – a joint statement from RCPCH, RCEM and RCGP

9 December 2022

Three Medical Royal Colleges are issuing advice for worried parents and healthcare professionals working during a very tough winter.

The latest data from the UK Health Security Agency (UKHSA) shows that cases of Group A Strep infection, including scarlet fever, continues to remain higher than we would typically see at this time of year. Currently, there is no evidence that a new strain is circulating. This increase is most likely related to high amounts of circulating bacteria and social mixing. Please be assured that the situation is being closely monitored and assessed.

For parents and carers

Strep A is a very treatable infection that is well researched and widely recognised by the medical community.

The early symptoms of scarlet fever include:

• sore throat, headache, fever, nausea and vomiting
• after 12 to 48 hours, the characteristic red rash develops, usually first on the chest and stomach, then rapidly spreading to other parts of the body, making the skin have a sand-paper like feel to it. The scarlet rash may be harder to spot on darker skin, although the ‘sandpaper’ feel should be present
• patients usually have flushed red cheeks. They may also have a bright red ‘strawberry’ tongue.

We’d like to reassure parents and carers that Strep A is a common infection in children and most cases are mild or asymptomatic. In very rare occasions, the bacteria can get into the bloodstream or enclosed parts of the body like the chest and cause an illness called invasive Group A strep (iGAS).

The rising numbers of infections have understandably caused anxiety among parents. As with any winter period, there are lots of viruses that cause sore throats, colds and coughs and these should generally resolve without medical intervention.

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.

Contact NHS 111 or your GP if:

• your child is getting worse
• your child is feeding or eating much less than normal
• your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
• your baby is under 3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher
• your baby feels hotter than usual when you touch their back or chest, or feels sweaty
• your child is very tired or irritable.

Call 999 or go to A&E if:

• your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• there are pauses when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake.

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infection.

For healthcare professionals

Healthcare professionals should note the higher circulating rate this winter, and ‘think Group A Strep’.

UKHSA has stated that clinicians should maintain a high index of suspicion in relevant patients as early recognition and prompt initiation of specific and supportive therapy can make a significant difference.

Urgent notification to UKHSA Health Protection Teams of scarlet fever and iGAS infection is essential to facilitate immediate public health actions including contact tracing.

Demand for penicillin and amoxicillin has increased in recent days as the number of cases of Strep A has risen. Healthcare professionals may need to prescribe tablets and capsules and provide guidance on how children could be encouraged to swallow these. See our Medicines for Children website for advice on children swallow pills.

You can report any medicine shortages to the Department of Health and Social Care (DHSC) through the Discontinuations and Shortages (DaSH) portal.
“During any winter period colds, flus and bugs are widespread. But with the recent increase in Strep A cases, it’s no wonder that parents are very worried. We would like to reassure parents and carers that this specific infection is both common and treatable. In fact, the majority of children will recover on their own without the need for antibiotics.

“The UKHSA are monitoring the situation closely and healthcare professionals are now on high alert for any potential cases of Strep A and scarlet fever. As always, if parents are worried about their child’s health, we would urge that they seek medical assistance from a pharmacist, their GP or by calling 111 as a first port of call.”

RCPCH President, Dr Camilla Kingdon
RCEM President, Dr Adrian Boyle
RCGP President, Prof Kamila Hawthorne