Strep A and scarlet fever

There are currently high rates of Group A strep and scarlet fever in the UK. Scarlet fever, which is caused by the bacteria Group A streptococcus, is usually a mild illness but it is highly infectious. Scarlet fever is much more common in children than in adults and it is important that children with scarlet fever are seen by a healthcare professional so that they can be started on antibiotics. 

What should I look out for?

The rash of scarlet fever often begins with small spots on the body that then spread to the neck, arms and legs over the next 1-2 days. It is often ‘sand-paper’ like to touch but is not itchy.

Your child may also have a:

  • Sore throat/tonsillitis
  • Fever (temperature of 38°C (100.4°F) or above)
  • Painful, swollen glands in the neck
  • A red tongue (strawberry tongue)
Does my child need to be seen?

If you think that you child has scarlet fever, you should let your GP practice or NHS 111 know the same day. If a healthcare professional thinks that your child has scarlet fever, they will prescribe your child antibiotics. This reduces the chance of their infection becoming more severe but more importantly also stops them spreading the infection to others (after 24 hours of starting antibiotics), especially to people at higher risk of severe infections such as the elderly and those with weakened immune systems. NOTE: there are many causes of rash in children – if your child does not have the other features above, they are unlikely to have scarlet fever.

Group A strep can also cause tonsillitis (Strep throat) – your child is likely to have a high fever, severe sore throat and you will see pus on their tonsils. Children with likely strep throat should also be seen by a healthcare professional within 24-48 hours for consideration of antibiotics. NOTE: if your child also has a runny nose with their tonsillitis, it makes a diagnosis of strep throat far less likely and if your child has none of the red or amber features below, they are unlikely to require treatment with antibiotics.

My child has been in close contact with someone with Strep A – do they need antibiotics?

If your child has been in close contact with a case of scarlet fever or strep throat, they do not need to be treated with antibiotics unless they are showing signs of infection (severe tonsillitis with fever in the absence of a runny nose or signs of scarlet fever). Only in exceptional circumstances will the local public health team recommend for an entire school class to be treated with antibiotics.

My child has been diagnosed with scarlet fever or strep throat and is on antibiotics – what do I need to look out for?

Your child may continue to have a fever for a few days after starting antibiotics. Very rarely, Group A streptococcus can spread to other areas of the body (invasive Group A strep), causing infections in the neck (tonsillar abscesses or lymph node abscesses), behind the ear (mastoiditis), chest infections (pneumonia), bone and joint infections (septic arthritis) or sepsis. There is clear red / amber / green information below about what symptoms and signs to look our for to identify the child with possible invasive Group A strep or other complications of Group A strep.

Strep A and scarlet fever :: Healthier Together (