News story

UKHSA update on scarlet fever and invasive group A strep

Latest data from the UK Health Security Agency (UKHSA) on scarlet fever and invasive group A strep cases.

Latest update

The latest data from the UK Health Security Agency (UKHSA) continues to show that scarlet fever infections remain high, although the number of notifications has fallen in recent weeks.

So far this season (from 19 September to 15 January), there have been 38,429 notifications of scarlet fever. In the last comparably high season of 2017 to 2018 (September to August), there were 30,768 scarlet fever notifications overall across the year. There has been a reduction in the weekly number of notifications over the last few weeks, suggesting a decrease in transmission of the bacteria.

Invasive group A strep (iGAS) infections remain rare but are currently higher than we see in a typical year. So far this season there have been:

  • 1,675 iGAS cases across all age groups, compared to 2,967 across the whole of the last comparably high season in 2017 to 2018
  • 190 iGAS cases in children aged 1 to 4 compared to 194 cases in the 2017 to 2018 season
  • 132 cases in children aged 5 to 9 years compared to 117 during the 2017 to 2018 season

The number of weekly notifications of iGAS in children has decreased. However, in older age groups, particularly those over 65 years old, infections have not slowed at the same rate and we are monitoring this closely. As with previous seasons, over recent weeks the majority of iGAS cases continue to be in those over 45 years.

Sadly, so far this season there have been 211 deaths across all age groups in England. This figure includes 30 children under 18 in England. In the 2017 to 2018 season (September to August), there were 355 deaths in total across the season, including 27 deaths in children under 18.

Dr Derren Ready, UKHSA incident director, said:

Although the number of scarlet fever notifications we are seeing each week is falling, the bacteria that cause the infection are still circulating at high levels. It’s also not unusual to have a dip in the number of cases before the spring, so we could see infections rise again in the coming months. Please contact NHS 111 or your GP if you suspect you or your child have scarlet fever – with symptoms such as fever, sore throat, difficulty swallowing and a sandpapery rash.

Early treatment of scarlet fever with antibiotics is important to reduce the risk of a more serious infection and transmission to others. Children should stay off school or nursery and adults should stay off work for 24 hours after antibiotics have started.

It’s not too late to take up the free flu and coronavirus (COVID-19) vaccines if you’re eligible – we know that group A streptococcus infections can be more serious when combined with another infection including flu.

Most winter illnesses can be managed at home and NHS.UK has information to help parents look after children with mild illnesses. Contact NHS 111 or your GP surgery if you think your child is getting worse, for instance, if they are feeding or eating less than normal, are dehydrated, have a high temperature that won’t go down, are very hot and sweaty or seem more tired or irritable than normal.

It is important that we continue to help stop the spread of all germs in the community and to vulnerable groups. Wash your hands regularly and thoroughly, catch coughs and sneezes in a tissue, and keep your home well-ventilated. If you are unwell with any infection you should avoid visiting vulnerable people, and stay away from school, nursery or work if you are unwell with a fever.

Previous updates

Thursday 12 January 2023

Latest data from the UK Health Security Agency (UKHSA) continues to show scarlet fever and group A strep (GAS) infections remain high, although the number of notifications has fallen in recent weeks.

So far this season (from 19 September to 8 January), there have been 37,068 notifications of scarlet fever. This compares to a total of 4,490 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018, there were 30,768 scarlet fever notifications overall across the year.

Invasive group A strep (iGAS) infections remain rare but are currently higher than we see in a typical year. So far this season there have been 1,539 iGAS cases across all age groups, compared to 2,967 across the whole of the last comparably high season in 2017 to 2018. So far this season, there have been 177 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole of the 2017 to 2018 season.

There have been 128 cases in children aged 5 to 9 years compared to 117 across the whole of the 2017 to 2018 season. As with previous seasons, over recent weeks the majority of iGAS cases continue to be in those over 45 years. There are early indications of an increase of iGAS notifications in the older age groups in recent weeks and we will monitor this trend closely.

Sadly, so far this season there have been 190 deaths across all age groups in England. This figure includes 30 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Dr Sarah Anderson, UKHSA incident director, said:

The number of scarlet fever notifications we are seeing each week has fallen, but we are continuing to monitor the data closely as the school term gets underway, and children mix more. The bacteria that cause scarlet fever are still circulating at high levels so it is important that we continue to do our bit to stop the spread of germs to vulnerable groups, including the elderly by washing our hands regularly and thoroughly, catching coughs and sneezes in a tissue, and keeping our homes well ventilated.

It’s not too late to take up the free flu and COVID-19 vaccines if you’re eligible – we know that group A streptococcus infections can be more serious when combined with another infection like flu.

Most winter illnesses can be managed at home and NHS.UK has information to help parents look after children with mild illness. Deaths and serious illness following group A strep infection are very rare and the infection can be easily treated with antibiotics.

Contact NHS 111 or your GP surgery if you think your child is getting worse, for instance they are feeding or eating less than normal, are dehydrated, have a high temperature that won’t go down, are very hot and sweaty or seem more tired or irritable than normal.

Thursday 5 January 2022

Latest data from the UK Health Security Agency (UKHSA) continues to show scarlet fever and group A strep (GAS) infections remain high.

So far this season (from 19 September to 1 January) there have been 35,616 notifications of scarlet fever. This compares to a total of 4,192 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018 there were 30,768 scarlet fever notifications overall across the year.

Invasive group A strep (iGAS) infections remain rare but are currently higher than we see in a typical year. So far this season, there have been 159 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season in 2017 to 2018. There have been 118 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of iGAS cases continue to be in those over 45 years.

Sadly, so far this season there have been 151 deaths across all age groups in England. This figure includes 29 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Dr Obaghe Edeghere, UKHSA incident director, said:

As children return to school, scarlet fever and ‘strep throat’ continue to circulate at high levels and so it is important that we all wash our hands regularly and thoroughly and catch coughs and sneezes in a tissue. This will help stop germs spreading between children and to other vulnerable groups and will help prevent the spread of other winter illnesses that are currently circulating at high levels, including flu and COVID-19.

It’s not too late to take up the free flu and COVID-19 vaccines if you’re eligible – we know that group A strep infections can be more serious when combined with another infection like flu.

Most winter illnesses can be managed at home and NHS.UK has information to help parents look after children with mild illness. Deaths and serious illness following group A strep infection are very rare and the infection can be easily treated with antibiotics.

Speak to a healthcare professional if you think your child is getting worse, for instance they are feeding or eating less than normal, are dehydrated, have a high temperature that won’t go down, are very hot and sweaty or seem more tired or irritable than normal.

Thursday 29 December 2022

Latest data from the UK Health Security Agency (UKHSA) continues to show an out of season increase in scarlet fever and group A streptococcus infections and a higher number of cases than seen in a typical year.

So far this season (from 19 September to 25 December) there have been 33,836 notifications of scarlet fever. This compares to a total of 4,672 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018 there were 30,768 scarlet fever notifications overall across the year.

Invasive group A streptococcus (iGAS) infections remain rare. So far this season, there have been 151 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season in 2017 to 2018. There have been 102 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of iGAS cases continue to be in those over 45 years.

Sadly, so far this season there have been 122 deaths across all age groups in England. This figure includes 25 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Dr Obaghe Edeghere, UKHSA incident director, said:

We are continuing to see a rise in scarlet fever and ‘strep throat’ and this is understandably concerning for parents. However I would stress that the condition can be easily treated with antibiotics and it is very rare that a child will go on to become more seriously ill.

Over the winter, there are lots of illnesses circulating that can make children unwell and so it is important to avoid contact with other people if you are feeling unwell, wash your hands regularly and thoroughly and catch coughs and sneezes in a tissue. I would also urge all those eligible for free winter vaccines to take advantage of these.

Most winter illnesses can be managed at home and NHS.UK has information to help parents look after children with mild illness. However please do make sure you speak to a healthcare professional if you believe your child is getting worse for instance they are feeding or eating less than normal, are dehydrated, has a high temperature that won’t go down, is very hot and sweaty or seems more tired or irritable than normal.

Thursday 22 December 2022

Latest data from the UK Health Security Agency (UKHSA) continues to show an out of season increase in scarlet fever and group A streptococcus infections and a higher number of cases than seen in a typical year.

So far this season (from 12 September to 18 December) there have been 27,486 notifications of scarlet fever. This compares to a total of 3,287 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018 there were 30,768 scarlet fever notifications overall across the year.

Invasive group A streptococcus (iGAS) infections remain rare. So far this season, there have been 126 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season in 2017 to 2018. There have been 88 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of iGAS cases continue to be in those over 45 years.

Sadly, so far this season there have been 94 deaths across all age groups in England. This figure includes 21 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Dr Colin Brown, Deputy Director, UKHSA, said:

I understand how this large rise in scarlet fever and ‘strep throat’ may be concerning to parents, however the condition can be easily treated with antibiotics and it is very rare that a child will go on to become more seriously ill. At this time of year, there are lots of winter illnesses circulating that can make children unwell and I would urge all those eligible for free winter vaccines to take advantage of these.

Most winter illnesses can be managed at home and NHS.UK has information to help parents look after children with mild illness. NHS services are under huge pressure this winter, but please visit NHS.UK, contact 111 online or your GP surgery if your child has symptoms of scarlet fever or ‘strep throat’ so they can be assessed for treatment.

Thursday 15 December 2022

Latest data from the UK Health Security Agency (UKHSA) continues to show an out of season increase in scarlet fever and group A streptococcus infections.

So far this season (from 12 September to 11 December) there have been 7,750 notifications of scarlet fever. This compares to a total of 2,538 at the same point in the year during the last comparably high season in 2017 to 2018 – although cases in that season started to rise at a different point. In 2017 to 2018 there were 30,768 scarlet fever notifications overall across the year.

Invasive group A streptococcus (iGAS) infections remain rare. So far this season, there have been 111 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole year of the last comparably high season* in 2017 to 2018. There have been 74 cases in children aged 5 to 9 years compared to 117 across the whole year of the last comparably high season in 2017 to 2018. The majority of cases continue to be in those over 15 years.

Sadly, so far this season there have been 74 deaths across all age groups in England. This figure includes 16 children under 18 in England. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

*We analyse scarlet fever seasons from week 37 to week 36 the following year. The majority of cases would typically be seen from the beginning of February to April.

Dr Colin Brown, Deputy Director, UKHSA, said:

Scarlet fever and ‘strep throat’ will make children feel unwell, but can be easily treated with antibiotics. Symptoms to look out for include fever, sore throat, swollen glands, difficulty swallowing, and headache. Scarlet fever causes a sandpapery rash on the body and a swollen tongue. NHS services are under huge pressure this winter, but please visit NHS.UK, contact 111 online or your GP surgery if your child has symptoms of scarlet fever or ‘strep throat’ so they can be assessed for treatment.

At this time of year, there are lots of winter illnesses circulating that can make children unwell. Most of these can be managed at home and NHS.UK has information to help parents look after children with mild illness.

It is very rare that a child will go on to become more seriously ill, but parents know better than anyone else what your child is usually like, so you’ll know when they are not responding as they would normally. Make sure you speak to a healthcare professional if your child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection – look out for signs such as a fever that won’t go down, dehydration, extreme tiredness, intense muscle pains, difficulty breathing or breathing very fast.

Good hand and respiratory hygiene are important for stopping the spread of many germs. 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 infections.

The first symptoms of scarlet fever include flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck).

A rash appears 12 to 48 hours later. It looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper.

On white skin the rash looks pink or red. On brown and black skin it might be harder to see a change in colour, but you can still feel the rash and see the raised bumps.

Contact 111 (online if child over 5) or GP surgery if your child has scarlet fever symptoms.

Symptoms can include nausea and vomiting.

The symptoms of ‘strep’ throat include:

Contact 111 (online if child over 5) or GP surgery if your child has ‘strep’ throat symptoms.

The symptoms of iGAS include:

  • high fever
  • severe muscle aches
  • localised muscle tenderness
  • increasing pain, swelling and redness at site of wound
  • unexplained diarrhoea or vomiting

There are several viruses circulating that cause sore throats, colds and coughs. These should resolve without needing medical attention. Antibiotics are not needed for viral infections. However, children can on occasion develop a bacterial infection at the same time as a virus and that can make them more unwell.

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. Contact NHS 111 (online if child over 5) or your GP surgery 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 3 to 6 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

Cases of GAS usually increase during the winter and the last time significant numbers of cases were reported was in the 2017 to 2018 season. Seasons with high cases can occur every 3 to 4 years but social distancing measures implemented during the coronavirus (COVID-19) pandemic may have interrupted this cycle and may explain the current increase being observed.

While invasive group A strep is rare, close contacts of cases are at greater risk of developing the infection. Health protection teams follow national guidance to manage the contacts of iGAS cases and advise preventative treatment if necessary.

Following an evidence review of individuals who are at greater risk of invasive group A strep, UKHSA has updated guidance to expand the number of vulnerable groups who would be potentially eligible for prophylactic antibiotics following a risk assessment by health protection teams. This evidence review was underway before the current rise in cases, and is now being implemented.

Data published by Public Health Wales and Public Health Scotland is also available.

Thursday 8 December 2022

The latest data from the UK Health Security Agency (UKHSA) continue to indicate that there is an out of season increase in scarlet fever and group A strep infections. Cases usually show steepest rises in the new year, but have increased sharply in recent weeks.

So far this season (from 12 September to 4 December) there have been 6,601 notifications of scarlet fever. This compares to a total of 2,538 at the same point in the year during the last comparably high season in 2017 to 2018.

In very rare occasions, the bacteria causing scarlet fever, group A streptococcus (GAS) can get into the bloodstream and cause an illness called invasive group A strep (iGAS), which can be very serious, particularly in older, younger and more vulnerable groups. iGAS cases across all age groups are slightly higher than expected at this time of year. The latest data continues to highlight a higher proportion of iGAS cases in children than we would normally see. However, iGAS remains uncommon.

So far this season, there have been 85 iGAS cases in children aged 1 to 4 compared to 194 cases in that age group across the whole of the last comparably high season in 2017 to 2018. There have been 60 cases in children aged 5 to 9 compared to 117 across the whole of the last comparably high season in 2017 to 2018. The majority of cases continue to be in those over 45.

Sadly, so far this season there have been 60 deaths across all age groups in England. This figure includes 13 children under 18. In the 2017 to 2018 season, there were 355 deaths in total across the season, including 27 deaths in children under 18.

Cases of GAS usually increase during the winter and the last time significant numbers of cases were reported was in the 2017 to 2018 season. Seasons with high cases can occur every 3 to 4 years but social distancing measures implemented during the coronavirus (COVID-19) pandemic may have interrupted this cycle and explain the current increase being observed.

Currently, there is no evidence that a new strain of GAS is circulating or any increase in antibiotic resistance. Antibiotics are the best treatment and work well against the circulating strains. The increase is likely to reflect increased susceptibility to these infections in children due to low numbers of cases during the pandemic, along with current circulation of respiratory viruses, which may increase the chances of children becoming seriously unwell. However, investigations are under way to understand if there are other factors that could be contributing to the increase this season and to better understand who is currently most affected.

Dr Colin Brown, Deputy Director, UKHSA, said:

Scarlet fever and ‘strep throat’ are common childhood illnesses that can be treated easily with antibiotics. Please visit NHS.UK, contact 111 online or your GP surgery if your child has symptoms of this infection so they can be assessed for treatment.

Very rarely, the bacteria can get into the bloodstream and cause more serious illness called invasive group A strep. We know that this is concerning for parents, but I want to stress that while we are seeing an increase in cases in children, this remains very uncommon. There are lots of winter bugs circulating that can make your child feel unwell, that mostly aren’t cause for alarm. However, make sure you talk to a health professional if your child is getting worse after a bout of scarlet fever, a sore throat or respiratory infection – look out for signs such as a fever that won’t go down, dehydration, extreme tiredness and difficulty breathing.

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 infections.

There are lots of viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell. As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.

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

Note: We analyse scarlet fever seasons from week 37 to week 36 the following year. The majority of cases would typically be seen from the beginning of February to April.

Friday 2 December 2022

The latest data from the UK Health Security Agency (UKHSA) shows that scarlet fever cases continue to remain higher than we would typically see at this time of year.

There were 851 cases reported in week 46, compared to an average of 186 for the preceding years.

Scarlet fever is usually a mild illness, but it is highly infectious. Therefore, look out for symptoms in your child, which include a sore throat, headache, and fever, along with a fine, pinkish or red body rash with a sandpapery feel. On darker skin, the rash can be more difficult to detect visually but will have a sandpapery feel. Contact NHS 111 or your GP if you suspect your child has scarlet fever, because early treatment of scarlet fever with antibiotics is important to reduce the risk of complications such as pneumonia or a bloodstream infection. If your child has scarlet fever, keep them at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.

Scarlet fever is caused by bacteria called group A streptococci. These bacteria also cause other respiratory and skin infections such as strep throat and impetigo.

In very rare occasions, the bacteria can get into the bloodstream and cause an illness called invasive group A strep (iGAS). While still uncommon, there has been an increase in invasive group A strep cases this year, particularly in children under 10. There were 2.3 cases per 100,000 children aged 1 to 4 compared to an average of 0.5 in the pre-pandemic seasons (2017 to 2019) and 1.1 cases per 100,000 children aged 5 to 9 compared to the pre-pandemic average of 0.3 (2017 to 2019) at the same time of the year.

So far this season there have been 5 recorded deaths within 7 days of an iGAS diagnosis in children under 10 in England. During the last high season for group A strep infection (2017 to 2018) there were 4 deaths in children under 10 in the equivalent period.

Investigations are also underway following reports of an increase in lower respiratory tract group A strep infections in children over the past few weeks, which have caused severe illness.

Currently, there is no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria and social mixing.

There are lots of viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell.

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 3 to 6 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 infections.

Dr Colin Brown, Deputy Director, UKHSA, said:

We are seeing a higher number of cases of group A strep this year than usual. The bacteria usually causes a mild infection producing sore throats or scarlet fever that can be easily treated with antibiotics. In very rare circumstances, this bacteria can get into the bloodstream and cause serious illness – called invasive group A strep (iGAS). This is still uncommon; however, it is important that parents are on the lookout for symptoms and see a doctor as quickly as possible so that their child can be treated and we can stop the infection becoming serious. Make sure you talk to a health professional if your child is showing signs of deteriorating after a bout of scarlet fever, a sore throat, or a respiratory infection.

Published 2 December 2022
Last updated 19 January 2023 + show all updates
  1. Added latest update.

  2. Added latest update.

  3. Added latest update.

  4. Added latest update.

  5. Added latest update.

  6. Added latest update.

  7. Updated information on when to contact NHS 111 or GP in 2 December update.

  8. First published.