Research and analysis

Group A streptococcal infections: third update on seasonal activity in England, 2025 to 2026

Updated 28 May 2026

Applies to England

Main points

Scarlet fever in-hours GP consultations for the current 2025 to 2026 group A streptococcal (GAS) season look to be declining after experiencing a peak at the beginning of the year. Notifications remain in line with normal seasonal levels. Laboratory notifications of invasive group A streptococcal (iGAS) infection are similarly within expected levels, though levels have remained relatively consistent with no distinct seasonal peaks.

Given the potential for severe presentations, scarlet fever cases should be treated promptly with antibiotics to limit further spread and reduce risk of potential complications in cases and their close contacts. Clinicians should continue to be alert to the severe complications of GAS infections and maintain a high degree of clinical suspicion when assessing patients, particularly those with preceding viral infection (including chickenpox) or their close contacts. Tetracycline resistance is being more frequently identified in iGAS isolates at this point in the season; clinicians should continue to consider the full antibiogram when treating patients with reported penicillin allergy.

Updated UK public health guidance on the management of close contacts of iGAS cases in community settings was published on 15 December 2022, with public health action extended to include patients with probable invasive GAS infection and additional close contact groups recommended for antibiotic prophylaxis. The evidence base underpinning the change in risk groups has been published.

National guidance on the management of scarlet fever outbreaks highlights essential tools to limit spread:

• prompt notification of scarlet fever cases and outbreaks to UK Health Security Agency (UKHSA) health protection teams (HPTs)
• collection of throat swabs (prior to commencing antibiotics) when there is uncertainty about the diagnosis
• exclusion of cases from school and work until 24 hours of antibiotic treatment has been received

Numbers presented in this seasonal activity update are based on data available as of 20 May 2026 for diagnoses up to and including 17 May 2026 (end of week 20). Numbers presented may change as updated data becomes available.

The information presented in this report is presented on the UKHSA data dashboard, where aggregate numbers can also be downloaded.

Key definitions are available at the end of the report.

Scarlet fever

So far this season (week 37 2025 to week 20 2026), scarlet fever activity is following expected patterns, notifications are now declining following seasonal peaks in February and March (Figure 1). With the highest weekly rate of in-hours GP consultations so far being observed in week 12 2026 at 1.34 per 100,000 registered population. For the latest week, the rate (0.65 per 100,000 registered population, week 20 2026) falls within the range (0.05 to 1.99) observed for the same week in the last 6 seasons (2019/2020 season to 2024/2025 season, excluding the 2022/2023 upsurge season).

Figure 1. Weekly scarlet fever notifications in England, 2019 to 2020 onwards

Note: data shown for the current season goes up to week 20 (17 May 2026).

Invasive group A streptococcal infection

Laboratory notifications of iGAS infection so far this season (week 37, 2025 up to week 20, 2026) have displayed a relatively persistent trend, with no definite peaks (Figure 2). Numbers remain within the range expected at this time of year. A total of 1,740 notifications of iGAS disease have been received to date this season, with the highest weekly total reported in week 8 with 62 notifications (week commencing 16 February 2026). Cumulative numbers of iGAS infections to date this season are slightly higher than the average (1,648) but still fall within the range (587 to 2,155) for the same period in the prior 5 seasons (2019/20 to 2024/25 seasons, excluding the 2022/23 upsurge season).

At this point in the season (up to week 20), the highest notification rates were observed in the North East (4.4 per 100,000 population), followed by the Yorkshire and The Humber (4.1 per 100,000). Lowest rates were seen in London and the East of England (both 2.3 per 100,000).

Figure 2. Weekly laboratory notifications of invasive GAS, England, 2019 to 2020 season onwards

Note: Numbers of notifications in the latest weeks of the 2025/26 season are expected to increase due to a lag in laboratory reporting. The decline in notifications in recent weeks should be interpreted with caution; delayed processing and reporting timeframes are represented by a dashed line between weeks 18 and 20 of 2026.

Rates of iGAS infection to date this season are highest in those aged 75 years and over (10.9 per 100,000), with the second highest rate so far is in those individuals aged under 1 year (4.4 per 100,000). The lowest notification rate (0.4 per 100,000) was observed in cases aged 10-14 years.

The median age of notified cases of iGAS infection this season is 63 years (range of 0 to 106 years). This is slightly higher than the range of median age reported for this point in the preceding 5 seasons (51 to 61 years).

Antimicrobial susceptibility results from routine laboratory surveillance for iGAS infection (weeks 37, 2025, to 20, 2026) continue to show elevated levels of tetracycline and erythromycin resistance, higher than the range seen in the previous 6 seasons, with co-resistance to both tetracycline and erythromycin identified in 13% of sterile site isolates. Co-trimoxazole resistance has been reported in 4.8% of iGAS cases in the 2025/26 season so far (3.4% of iGAS cases in the 2024/25 season). Changes in the resistance rates are likely to reflect dominant emm types currently circulating this season.

Specifically:

• 9.7% were resistant to clindamycin (8.3% in 2024/25; range 5.0% to 12.6% in the last 6 seasons)
• 29.6% were resistant to erythromycin (17.8% in 2024/25; range 6.4% to 17.8% in the last 6 seasons)
• 48% were resistant to tetracycline (40.6% in 2024/25; range 16.1% to 40.6% in the last 6 seasons)

Analysis of reference laboratory sterile-site iGAS isolate submissions indicated a diverse range of emm gene sequence types identified to date this season (week 37 2025 to week 18 2026), with emm 49.8 remaining the most common type (21.5% of all referrals), followed by emm 8.0 (7.1%) and emm 89.0 (6.2%). This compares to emm 49.8 (14.1%), emm 89.0 (6.7%) and emm 8.0 (5.8%), which were the top 3 emm types at a similar point in the previous season.

Discussion

Following the 2022/23 season, which saw a period of considerable elevation in scarlet fever notifications (1,2) and unusual seasonal patterns, the 2023/24 season saw a return to more usual GAS activity. GP-in hours rates for scarlet fever, at this point in the 2025/26 season, continue to be within expected levels for the season.

Emergency department attendances for scarlet fever have fallen since the previous report where an increase was noted in week 10 (3). Other syndromic indicators remain within usual levels.

Invasive GAS infection cases this season have not displayed any distinct peaks or notable trends and remain at a persistent level, though are within the usual range for this time of year. Incidence by age group follows the expected pattern with highest rates in the elderly.

Of note this season, the antimicrobial resistance in second line therapeutic agents (like tetracyclines and macrolides) remains elevated. This is likely a result of emm 49.8 being the dominant emm type this season, as more than 95% emm 49.8 isolates are resistant to both tetracycline and erythromycin, but predominantly susceptible to co-trimoxazole and clindamycin. GAS remains universally susceptible to penicillin which remains the drug of choice.

Prompt treatment of scarlet fever with antibiotics is recommended to reduce risk of possible complications and limit onward transmission. GPs and other frontline clinical staff are also reminded of the increased risk of invasive disease among household contacts of scarlet fever cases (4,5). Clinicians should continue to maintain a high index of suspicion in relevant patients for invasive disease as early recognition facilitates prompt initiation of specific and supportive therapy for patients with iGAS infection.

Relevant guidelines and FAQs are available on GOV.UK:

• Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings
• Scarlet fever: symptoms, diagnosis and treatment
• Guidelines for the management of close community contacts of invasive GAS cases
• Prevention and control of group A streptococcal infection in acute healthcare and maternity settings
• Report a Notifiable Disease (eNOIDS)

All invasive disease isolates – and also non-invasive isolates – from suspected clusters or outbreaks should be submitted for typing to:

Staphylococcus and Streptococcus Reference Section
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI)
UK Health Security Agency
61 Colindale Avenue
London
NW9 5HT

Further information on health equity groups is published annually within the annual streptococcal bacteraemia report, describing trends ethnic group and deprivation for GAS bacteraemia.

Data from this report, and from the routine weekly syndromic surveillance scarlet fever GP-in hours rates, are available on the UKHSA Dashboard.

Data sources and methods

Scarlet fever data is presented as GP in-hours consultation rates per 100,000 registered population. This information is collected from UKHSA’s GP in-hours syndromic surveillance system. This system is sentinel, which means that not all GP practices in England are included, and coverage varies by UKHSA region, so comparison between geographic regions is not recommended. The system currently includes approximately 19 million registered patients across England. The data included is from 2 sources: technology provider TPP and ORCHID (Oxford and Royal College of General Practitioners Clinical Informatics Digital Hub). The indicator for scarlet fever syndromic is based on diagnoses recorded during GP in-hours patient consultations, and diagnoses are based on signs/symptoms and may not be laboratory confirmed. The weekly rates presented differ from the daily rates reported as standard elsewhere (6).

Invasive GAS laboratory notification data was extracted from the UKHSA Second Generation Surveillance System (SGSS) and combined with specimen referrals to the Staphylococcus and Streptococcus Reference Section to produce a total number of episodes for England. Data was extracted on 20 May 2026.

Antimicrobial resistance data is based on phenotypic test results for tetracycline, erythromycin, or clindamycin reported by laboratories to SGSS and are reported as susceptible or resistant. Co-resistance data is based on data where both tetracycline and erythromycin results have been reported for the iGAS episode.

Population rates are calculated per 100,000 using the relevant year’s ONS mid-year population estimate.

The M protein gene (emm) encodes the cell surface M virulence protein. Information for the emm gene was extracted from UKHSA’s reference laboratory and this report contains data covering the period 8 September 2025 to 2 May 2026.

Prior to the COVID-19 pandemic, there were a number of seasons when elevated incidence of scarlet fever and iGAS was seen, in particular the 2017 to 2018 season. During the pandemic there was an unprecedented reduction in the number of scarlet fever and iGAS notifications, affecting the 2019 to 2020 season and the 2021 to 2022 season.

References

1. UKHSA (2023). ‘Group A streptococcal infections: 15th update on seasonal activity in England’ Health Protection Report volume 17, number 7

2. Guy R, Henderson KL, Coelho J, Hughes H, Mason EL, Gerver SM and others (2023). ‘Increase in invasive group A streptococcal infection notifications, England, 2022’ Eurosurveillance: volume 28, number 1

3. UKHSA (2026). ‘Group A streptococcal infections: second update on seasonal activity in England, 2025 to 2026’ Health Protection Report volume 20, number 3

4. Lamagni T, Guy R, Chand M, Henderson KL, Chalker V, Lewis J, and others (2018). ‘Resurgence of scarlet fever in England, 2014 to 2016: a population-based surveillance study’ The Lancet Infectious Diseases: volume 18, number 2, pages 180 to 187

5. Watts V, Balasegaram S, Brown CS, Mathew S, Mearkle R, Ready D, and others (2019) . ‘Increased risk for invasive group A streptococcus disease for household contacts of scarlet fever cases, England, 2011 to 2016’ Emerging Infectious Diseases: volume 25, number 3, pages 529 to 537

6. UKHSA (2024). ‘Syndromic Surveillance Systems and Analyses’

Acknowledgements

These reports would not be possible without the weekly contributions from microbiology colleagues in laboratories across England, without whom there would be no surveillance data.

This report was prepared by: Eleanor Blakey, Kartyk Moganeradj, Rebecca Guy, and Theresa Lamagni.

Feedback and specific queries about this report are welcome via hcai.amrdepartment@ukhsa.gov.uk