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Strep A and Scarlet Fever

Scarlet fever is an illness caused by a bug called Group A Streptococcus, which is found on the skin and in the throat. Scarlet fever mostly affects children and can easily spread to other people.

Generally, scarlet fever is much less common than it used to be but in the last few years there have been a number of outbreaks.  It is important that children with scarlet fever are assessed by a healthcare professional so that they can be started on antibiotics.

The scarlet fever rash often begins with small spots on the body that then spread to the neck, arms and legs over the next 1 to 2 days. The rash may be harder to see on darker skin tones. It often feels like 'sandpaper' but is not itchy. 

Your child may also have a:

  • Sore throat or tonsillitis

  • Fever (temperature of 38°C or above)

  • Painful, swollen glands in the neck

  • A red tongue (strawberry tongue)

A picture showing a scarlet fever rash on the chest and arms of a child, and a child's red tongue (strawberry tongue)

 

A picture showing the scarlet fever rash on darker skin

Picture credit: Skin Deep

 

If your child also has a runny nose with their sore throat, it makes a diagnosis of scarlet fever and Group A strep less likely.

When should you worry?

If your child has any of the following:

  • Breathing very fast, too breathless to talk, eat or drink 

  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)

  • Breathing that stops or pauses

  • Is pale, blue, mottled or feels unusually cold to touch

  • Difficult to wake up, very sleepy or confused

  • Weak, high-pitched cry or can’t be settled

  • Has a fit (seizure)

  • Has a rash that does not go away with pressure (the ‘Glass Test’) 

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Unable to swallow saliva

  • Painful, red swollen neck glands

  • Painful, swollen joints

  • Puffy face or eyelids 

  • Dark coca-cola coloured wee (urine)

  • Develops red lips or a red tongue

  • Develops a lot of skin peeling

  • Breathing a bit faster than normal or working a bit harder to breathe

  • Dry skin, lips or tongue

  • Not had a wee or wet nappy in last 8 hours

  • Poor feeding in babies (less than half of their usual amount)

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)

  • Not using or putting weight on an arm, leg, hand or foot.

  • Complaining of severe pain that is not improving with painkillers

  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)

  • Temperature less than 36°C in those over 3 months

  • Getting worse or you are worried about them

You need to contact a doctor or nurse today.

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

None of the above features are present:

  • Watch them closely for any change and look out for any red or amber symptoms

  • If your child has any other symptoms associated with their fever, you may want to look at the information on sore throat, cough, earache, diarrhoea and vomiting or tummy ache or our other pathways.

  • Additional advice is also available to young families for coping with crying of well babies – click here.

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

What should you do?

Important

Keep your child away from nursery or school for at least 24 hours after starting antibiotic treatment. Adults with scarlet fever should also stay off work for at least 24 hours after starting treatment. 

Self-care

Many of the symptoms of scarlet fever can be relieved using some simple self-care measures, such as:

  • drinking plenty of cool fluids

  • eating soft foods (if your throat is painful)

  • taking paracetamol to bring down a high temperature/distress

  • using calamine lotion or antihistamine tablets can help relieve itching

Is Scarlet Fever dangerous?

Most cases of scarlet fever don't cause problems, particularly if the condition is properly treated. 

Rarely, the infection can spread to other parts of the body and cause more serious infections such as chest infections, bone and joint infections and sepsis.

Some of the problems can arise a few weeks after infection including kidney problems and joint issues, please get in touch with your GP if you are concerned.

How to avoid spreading Scarlet fever?

Scarlet fever is very contagious and can easily spread to other people.  To reduce the chance of spreading Scarlet fever:

Do:

  • wash your hands often with soap and water

  • use tissues to trap germs from coughs or sneezes

  • bin used tissues as quickly as possible

Don’t:

  • do not share cutlery, cups, towels, clothes, bedding or baths with anyone who has symptoms of scarlet fever

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.

How long will your child's symptoms last?

Scarlet fever last for around 1 week.  If you do not take antibiotics, you can spread the infection for 2-3 weeks after your symptoms start.

Where should you seek help?

For wear and tear, minor trips and everything in between

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  • Visit a pharmacy if your child is ill, but does not need to see a GP
  • Remember that if your child's condition gets worse, you should seek further medical advice immediately
  • Help your child to understand - watch this video with them about going to the pharmacy

For information on common childhood illnesses go to What is wrong with my child?

The 0-19 Service for children and young people is delivered by Oxford Health NHS Foundation Trust and offers a single point of access for Health Visiting, School Nursing and the Family Nurse Partnership. You can contact the teams using the details below:

Single Point of Access (SPA): 01865 903 800

Email: cyp0-19@oxfordhealth.nhs.uk

Chat Health Parentline

Text us any time for confidential advice and support and you will have a response the next working day (Monday-Friday exluding Bank Holidays).

Parents and carers for children aged 0-4: Text 07312 263 081

Parents and carers of children aged 5-11: Text 07312 263 227

Young people aged 11-19 and their parents and carers: Text 07312 263 08

Health Visitors

Health visitors are registered nurses or midwives who have additional training in community public health nursing. They provide a universal service, targeted to individual needs for children aged 0-5 years. Learn more about the Oxfordshire Health Visiting Service here!

School and college Health Nurses

School Health Nurses are specialist public health nurses and have offices across Oxfordshire. They work very closely with Health Visitors to support school aged children. They are available for young people to access in secondary schools and colleges, and offer a service to children who are home educated. They work closely with children, young people and their families to support and promote health and wellbeing. Learn more about the Oxfordshire School and college Health Nursing Service here!

Family Nurse Partnership

The Family Nurse Partnership service supports parents who are aged 19 years or under at conception, or under 21 years if they have been in care. The Family Nurse works alongside younger parents in their home, offering health, wellbeing and development support and information from the early stages of pregnancy, usually up until your child is two. Learn more about the Family Nurse Partnership service here!

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?

Emergency Departments (A&E) provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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