2^nd December 2022

Dear Parents and carers

RE: Health Update from South London Health Protection Team

We have been informed that a number of children who have been diagnosed with suspected scarlet fever or chickenpox.

Chickenpox

Chickenpox is a mild and common childhood illness that most children catch at some point. It causes a rash of red, itchy spots that turn into fluid-filled blisters. They then crust over to form scabs, which eventually drop off. To prevent spreading the infection, keep children off nursery or school until all the spots have crusted over.

For most children, chickenpox is a mild illness that gets better on its own. But some children can become more seriously ill and need to see a doctor. Contact your GP straight away if your child develops any abnormal symptoms, for example:

• if the blisters on their skin become infected

• if your child has a pain in their chest or has difficulty breathing.

Scarlet Fever

Scarlet fever is also a mild childhood illness but unlike chickenpox, it requires antibiotic treatment. Symptoms include a sore throat, headache, fever, nausea and vomiting, followed by a fine red rash which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. On more darkly-pigmented skin, the scarlet rash may be harder to spot, but it should feel like ‘sandpaper’. The face can be flushed red but pale around the mouth. As the rash fades the skin on the fingertips, toes and groin area can peel.

If you think you, or your child, have scarlet fever:

• See your GP or contact NHS 111 as soon as possible

• Make sure that you/your child takes the full course of any antibiotics prescribed by the doctor.

• Stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection.

Complications

Children who have had chickenpox recently are more likely to develop more serious infection during an outbreak of scarlet fever and so parents should remain vigilant for symptoms such as a persistent high fever, cellulitis (skin infection) and arthritis. If you are concerned for any reason please seek medical assistance immediately.

If your child has an underlying condition which affects their immune system, you should contact your GP or hospital doctor to discuss whether any additional measures are needed.

You can find more information on chickenpox and scarlet fever on NHS choices: www.nhs.uk

Facts & Figures

Scarlet fever (sometimes called scarlatina) is an infectious disease caused by bacteria called Streptococcus pyogenes, or group A streptococcus (GAS). The same bacteria can also cause impetigo.

Scarlet fever is characterised by a rash, which usually accompanies a sore throat. Bacteria that cause the infection produce toxins (poisons), which cause the rash, a red and swollen tongue and flushed cheeks. The scarlet fever rash can be confused with measles.

Scarlet fever is mainly a childhood disease and is most commonly seen between the ages of 2 and 8 years. Although historically considered a dangerous disease, it is now much less serious. Since 2014, a rise in numbers of cases has been seen with 15,000 to 30,000 cases currently diagnosed each year in England.

Scarlet fever is highly contagious and is spread by close contact with someone carrying the bacteria. It takes around 2 to 5 days to develop symptoms after exposure to these bacteria. If you think you or your child has scarlet fever, you should consult your GP. The disease tends to be most common in the winter and spring and the treatment consists of a course of antibiotics.

Protection from scarlet fever
Scarlet fever is spread via the mucus and saliva of infected people. It can also be caught from sharing drinking glasses, plates or utensils they have used. To protect yourself from getting the illness you should:

• wash your hands often
• not share eating utensils with an infected person
• wash, or dispose of, handkerchiefs and tissues contaminated by an infected person
• be aware that you can catch scarlet fever by inhaling contaminated airborne
  droplets, if someone with the illness coughs or sneezes in the air near you.

If you think you, or your child, have scarlet fever:

• see your GP or contact NHS 111 as soon as possible
• make sure that you/your child take(s) the full course of any antibiotics prescribed. Although you or your child will feel better soon after starting the course of antibiotics, you must complete the course to ensure that you do not carry the bacteria in your throat after you have recovered
• stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection
• You can help stop the spread of infection through frequent hand washing and by not sharing eating utensils, clothes, bedding and towels. All contaminated tissues or handkerchiefs
  should be washed or disposed of immediately.

Scarlet fever symptoms:

the first symptoms of scarlet fever often include a sore throat, headache, fever,
nausea and vomiting.

• after 12 to 48 hours the characteristic fine red rash develops (if you touch it, it feels like sandpaper). Typically, it first appears on the chest and stomach, rapidly spreading to other parts of the body. On more darkly-pigmented skin, the rash may be harder to spot, although the ‘sandpaper’ feel should be present
• fever over 38.3º C (101º F) or higher is common
• white coating on the tongue, which peels a few days later, leaving the tongue looking red and swollen (known as ‘strawberry tongue’)
• swollen glands in the neck
• feeling tired and unwell
• flushed red face, but pale around the mouth. The flushed face may appear more
  ‘sunburnt’ on darker skin
• peeling skin on the fingertips, toes and groin area, as the rash fades.

It usually takes 2 to 5 days from infection before the first symptoms appear. However, the incubation period may be as short as 1 day and as long as 7 days. Scarlet fever usually clears up after a week, but it is advisable to visit your GP to get a
full diagnosis and proper treatment.

Scarlet fever is highly contagious. Bacteria are present in the mouth, throat or nose of an infected person, or someone carrying the bacteria without symptoms, and are spread by contact with that person’s mucus or saliva. This might be on cups, plates, pens, toys or surfaces, such as tables which might have been used or touched by someone carrying the bacteria. You can also catch the disease by breathing infected airborne droplets produced by a person’s coughing, sneezing or normal breathing.

Individuals at risk
Scarlet fever is mainly a childhood disease, with around 90% of cases occurring in children under 10 years old. It is most common in children between the ages of 2 and 8 years, with 4-year-olds most likely to develop the illness. Occasionally, outbreaks of
scarlet fever occur in nurseries and schools. People of all ages can catch scarlet fever, but the disease is much less common in adults.

Diagnosis and treatment
Most cases of scarlet fever will clear up on their own, but it is still best to see your GP if you, or your child, are showing symptoms. Having treatment for the illness speeds recovery and reduces risk of complications. You will also become non- contagious more quickly.

In most cases, doctors can diagnose scarlet fever from the symptoms alone. The diagnosis can be confirmed by taking a throat swab, which is then sent to a laboratory to identify the bacteria causing the infection. In some cases, a throat swab is not enough and a blood test may be needed.

The usual treatment for scarlet fever is a 10-day course of antibiotics. The fever will usually subside within 24 hours of starting this, but it is important to take the whole course to completely clear these bacteria from your throat and protect others from
becoming infected.

If scarlet fever is not treated with antibiotics, it can be infectious for 2-3 weeks after symptoms appear. Provided all prescribed antibiotics are taken as directed, most cases will not infect other people after 24 hours of treatment. Current guidance advises that
children should not return to nursery or school and adults to work until a minimum of 24 hours after starting antibiotic treatment.

If you have a high temperature you should drink plenty of fluids. You can also take paracetamol or ibuprofen to relieve discomfort.

Once you have had scarlet fever you are less likely to get it again.

Potential complications
Most cases of scarlet fever have no complications at all. However, in the early stages, there is a small risk that you might develop one of the following infections caused by the same bacteria (GAS) responsible for scarlet fever:

ear infection

• throat abscess
• pneumonia
• inflammation of the sinuses (sinusitis)
• skin/soft tissue infection (cellulitis)
• joint inflammation (arthritis)
• septicaemia
• meningitis.

Household contacts of scarlet fever patients are also at risk of developing scarlet fever or other infections caused by the same bacteria (see list above) and should seek medical advice if they develop new symptoms of concern.

On rare occasions, patients with scarlet fever can at a later stage of the disease
develop:

• bone or joint problems
• liver damage
• kidney damage
• heart damage

Patients, or their parents, should keep an eye out for any symptoms which might suggest these complications in the first few weeks after the main infection has cleared up and, if concerned, seek medical help immediately.

If you have any concerns about your health, see your GP or contact NHS 111.