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Scarlet Fever and Invasive Group A Streptococcus (iGAS) Infection


There is a higher than expected national increase in notifications of invasive group A streptococcus (iGAS) and scarlet fever. Scarlet fever and iGAS infection are both notifiable diseases

Scarlet Fever and Invasive Group A Streptococcus (iGAS) Infection

Clinicians should be aware of the unusually high seasonal pattern and maintain a high index of suspicion, especially in relevant patients (such as those with chickenpox, and women in the puerperal period).

Early recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection can be lifesaving.

Signs and symptoms of Scarlet Fever

Scarlet fever is a common childhood infection caused by streptococcus pyogenes, or group A streptococcus (GAS).

Early illness:

The symptoms are non-specific in early illness and may include sore throat, headache, fever, nausea and vomiting.

12 to 48 hours:

Characteristic red, generalised pinhead rash develops, typically first appearing on the chest and stomach, rapidly spreading to other parts of the body, giving the skin a sandpaper-like texture. On more darkly pigmented skin, the scarlet rash may be harder to spot, although the ‘sandpaper’ feel should be present.

Patients typically have flushed cheeks and pallor around the mouth.

This may be accompanied by a ‘strawberry tongue’.

During convalescence:

Desquamation of the skin occurs at the tips of fingers and toes, less often over wide areas of the trunk and limbs.

Differential diagnosis:

Measles, glandular fever and slapped cheek infections.


Although scarlet fever is usually a mild illness, patients can develop complications such as an ear infection, throat abscess, pneumonia, sinusitis or meningitis in the early stages and acute glomerulonephritis and acute rheumatic fever at a later stage.

Patients, or their parents, should keep an eye out for any symptoms which might suggest these complications and if concerned advised to seek medical help immediately.

Recommended actions:

  • Suspected scarlet fever can be confirmed by taking a throat swab for culture of group A streptococcus, although a negative throat swab does not exclude the diagnosis.
  • Consider taking a throat swab to:

i) assist with differential diagnosis

ii) if you suspect that the patient may be part of an outbreak

iii) if the patient is allergic to penicillin or iv) in regular contact with vulnerable individuals (e.g., healthcare worker)

  • Prescribe antibiotics without waiting for the culture result if scarlet fever is clinically suspected:



  • Advise exclusion from nursery / school / work for 24 hours after the commencement of appropriate antibiotic treatment
  • Notify your Health Protection Team, including information on the school/nursery attended if relevant

Additional Information

Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings 

Guidance for managing close contacts of invasive GAS disease and prevention of GAS infection in acute healthcare and maternity settings

Guidance for Health protection in education and childcare settings 

Information for the public on scarlet fever

Information for the public on sepsis

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