What is the historical significance of scarlet fever. How has the understanding of scarlet fever evolved over time. What are the current concerns regarding scarlet fever outbreaks. Why does scarlet fever continue to pose a threat in the modern era.

The Origins and Early Descriptions of Scarlet Fever

Scarlet fever, a once-dreaded illness, has a rich and complex history that spans several centuries. The disease, caused by a toxin produced by the bacteria Streptococcus pyogenes, was first notably described in 1553 by the Sicilian physician Giovanni Filippo Ingrassia. He termed the condition “rossalia,” vividly depicting patients with “numerous spots, large and small, fiery and red, of universal distribution so that the whole body appeared to be on fire.”

This initial description laid the groundwork for further scientific inquiry and differentiation from other rash-causing illnesses. German physicians in 1564 documented an outbreak of a similar disease, which they called “scarlatina anginosa.” They noted its particularly fatal impact on infants and described symptoms including:

• Sore throat
• Violent fever
• Vomiting
• Swelling of the parotid glands
• Distinctive rash

The Definitive Description of Scarlet Fever

In 1578, French nobleman Jean Cottyar of Poitiers provided what is considered the first definitive description of scarlet fever. He consolidated previous observations and added new elements, notably the appearance of purpura on the second or third day, accompanied by a sore throat. This comprehensive description helped establish scarlet fever as a distinct clinical entity.

The Evolution of Scarlet Fever Understanding

How did our understanding of scarlet fever progress over time? The 17th and 18th centuries saw rampant epidemics of scarlet fever across Europe and North America. However, it wasn’t until the 1920s that a breakthrough in understanding the disease’s etiology occurred.

In 1924, American bacteriologists Gladys and George Dick made a pivotal discovery. They demonstrated that:

1. The cause of scarlet fever was the beta-hemolytic organism Streptococcus pyogenes (S. pyogenes, also called group A streptococci)
2. A toxin produced by this organism could cause the severe downstream disease
3. The infection could potentially progress to the development of rheumatic fever later in life

This revelation marked a significant turning point in the scientific understanding of scarlet fever and paved the way for more targeted approaches to prevention and treatment.

Historical Management and Public Health Measures

From the 1920s until the discovery of antibiotics in the 1940s, how was scarlet fever managed? In the absence of effective treatments, public health officials relied on isolation and quarantine measures to control the spread of this deadly disease. Quarantine signs were placed in the windows of homes with infected patients, serving as a visual warning to the community.

These public health interventions, while primitive by today’s standards, played a crucial role in limiting the spread of scarlet fever during a time when it was still a significant threat to public health.

The Antibiotic Era and Changing Perceptions

The discovery of antibiotics in the 1940s revolutionized the treatment of bacterial infections, including scarlet fever. How did this impact the disease’s prevalence and mortality rates? With the advent of effective antibiotic treatments, scarlet fever transitioned from a dreaded, potentially fatal illness to a manageable condition.

This shift in treatment capability led to a dramatic reduction in mortality rates and a change in public perception of the disease. Scarlet fever was no longer viewed as the deadly scourge it once was, and its incidence declined significantly in many parts of the world.

Recent Resurgence and Current Outbreaks

Despite the availability of effective treatments, why has scarlet fever seen a resurgence in recent years? Since September 2022, there has been a significant outbreak of scarlet fever in children across Europe, with cases also increasing in the United States. This outbreak has been notable for several reasons:

• It appeared out of sync with typical seasonal patterns, beginning in late summer
• Higher mortality rates than normal have been observed
• Between September and November 2022, England reported 4,622 cases of scarlet fever, significantly higher than the previous 5-year average of 1,294
• 13 children under 15 in England have died since September 2022

Potential Factors Contributing to the Resurgence

What factors might be contributing to this unexpected increase in scarlet fever cases? While the exact reasons remain unclear, several hypotheses have been proposed:

1. Macrolide resistance in the causative bacteria
2. Weakened herd immunity
3. Environmental factors
4. The absence of a vaccine for group A strep
5. Seasonal factors, such as the start of the school year and colder weather leading to indoor crowding

The World Health Organization (WHO) has suggested that the observed increase in cases may coincide with the early start of the respiratory season and the high incidence of circulating respiratory viruses.

Challenges in Modern Scarlet Fever Management

Given the availability of antibiotics, why does scarlet fever continue to pose challenges in the modern era? Despite advances in treatment, several factors contribute to the ongoing concerns surrounding scarlet fever:

• Antibiotic resistance: The emergence of antibiotic-resistant strains of S. pyogenes complicates treatment
• Delayed diagnosis: The rarity of the disease in recent decades may lead to delayed recognition and treatment
• Complications: Even with prompt treatment, scarlet fever can lead to serious complications if not managed properly
• Lack of a vaccine: Unlike many other infectious diseases, there is no vaccine available for group A strep

These factors underscore the importance of continued vigilance and research in managing scarlet fever in the modern healthcare landscape.

The Importance of Ongoing Surveillance and Research

Why is continued monitoring and study of scarlet fever crucial? The recent outbreaks serve as a reminder that even diseases considered “conquered” can re-emerge as public health threats. Ongoing surveillance and research are essential for several reasons:

1. Early detection of outbreaks
2. Monitoring for changes in disease patterns or severity
3. Identifying emerging antibiotic resistance
4. Developing new treatment strategies
5. Informing public health policies and interventions

By maintaining a proactive approach to scarlet fever surveillance and research, healthcare systems can be better prepared to respond to future outbreaks and minimize their impact on public health.

Future Directions in Scarlet Fever Prevention and Treatment

What potential advancements might shape the future of scarlet fever management? As our understanding of the disease continues to evolve, several areas of research and development hold promise for improving prevention and treatment:

• Vaccine development: Efforts to create a vaccine against group A strep could significantly reduce the incidence of scarlet fever and related complications
• Novel antibiotics: Research into new classes of antibiotics may provide solutions to combat antibiotic-resistant strains
• Rapid diagnostics: Improving the speed and accuracy of diagnostic tests could lead to earlier detection and treatment
• Targeted therapies: Developing treatments that specifically neutralize the scarlet fever toxin could reduce symptom severity and complications
• Public health strategies: Refining approaches to outbreak management and prevention in light of modern social and environmental factors

These potential advancements offer hope for more effective management of scarlet fever in the future, potentially reducing its impact on global public health.

In conclusion, the history of scarlet fever serves as a testament to the ever-evolving nature of infectious diseases and the importance of continued vigilance in public health. From its early descriptions in the 16th century to its current resurgence, scarlet fever has challenged medical understanding and public health systems. As we face new outbreaks and emerging challenges, the lessons learned from scarlet fever’s past will undoubtedly inform our approach to managing this and other infectious diseases in the future.

A Deadly History and How it Prevails

Portrait of Dr. Giovanni Ingrassia.

Source: Wikimedia Commons

Scarlet fever is a disease that has significantly evolved in definition and management over the last several hundred years. The disease, which is caused by a toxin produced by the bacteria Streptococcus pyogenes, was once enormously prevalent amongst the global population and associated with high mortality rates. It eventually became effectively managed and relatively easy to treat via antibiotic administration. However, recent outbreaks demonstrate the need to keep the disease front-of-mind to successfully identify and track the pathogen, treat patients and prevent poor outcomes.

Why did scarlet fever used to be such a dangerous disease, and why (although the burden of disease is far less than in years past) do outbreaks continue to occur, even after the development of penicillin?

History of Scarlet Fever

The first notable description of what might have been scarlet fever was documented by the Sicilian physician Giovanni Filippo Ingrassia in 1553. Ingrassia, who was well-known for his anatomical studies and contributions to public health, called the disease “rossalia” and described the patient as having “numerous spots, large and small, fiery and red, of universal distribution so that the whole body appeared to be on fire.”

Throughout the remainder of the 1500s and most of the 1600s, various scientists and physicians around the world added elements to the definition of the disease, further distinguishing it from other rash-causing illnesses like measles. For example, German physicians described an outbreak of a similar disease to “rossalia” in 1564. They termed it “scarlatina anginosa,” noting that it was particularly fatal to infants and that patients presented with a sore throat, violent fever, vomiting and swelling of the parotid glands, in addition to a rash.

Illustrations from 1908 demonstrating the difference between the rashes of measles and scarlet fever.

Source: Wikimedia Commons

In 1578, the French nobleman Jean Cottyar of Poitiers was credited with providing the first definitive description of the disease by tying all previous descriptive elements together and adding a few—namely that purpura appeared in patients on the second or third day, accompanied by a sore throat.

While epidemics of scarlet fever raged through Europe and North America through the 17th and 18th centuries, it was not until the 1920s that the significance of the patient’s sore throat would be fully realized. In 1924, American bacteriologists Gladys and George Dick demonstrated that the cause of scarlet fever was the beta-hemolytic organism Streptococcus pyogenes (S. pyogenes, also called group A streptococci) and that a toxin produced by the organism could cause this severe downstream disease, or even progress to the development of rheumatic fever later in life.

A scarlet fever quarantine sign is displayed in the window of the home of an infected patient in 1940.

Source: Wikimedia Commons

From the 1920s until antibiotics were discovered in the 1940s, clinicians and public health officials could use the signs and symptoms of scarlet fever to isolate patients and prevent the spread of the deadly disease. This was achieved by placing quarantine signs in the windows of the homes of infected patients.

Current Outbreaks

Since September 2022, there has been a significant outbreak of scarlet fever in children in Europe, and more recently, there have been documented increases in cases in the U.S. This outbreak has been unique in that it first appeared out of sync with typical seasonality and has come with higher mortality rates than normal. For example, the outbreak began in late summer and has killed 13 children under 15 in England since September. Between September and November 2022, public health agencies in England reported 4,622 cases of scarlet fever, a value significantly higher than the previous 5-year average of 1,294.

While the reasons for the increase in scarlet fever are unclear, hypotheses include macrolide resistance, weakened herd immunity, environmental factors and the absence of a vaccine for the bacteria that cause the disease (group A strep) Additionally, rates of scarlet fever increase with the start of the school year and as winter approaches. This may be attributed to the absence of immunity or the greater risk of crowding indoors during colder months.

The World Health Organization (WHO) has stated that the observed increase in cases may coincide with the early start of the respiratory season and the high incidence of circulating respiratory viruses. Additionally, children may be more significantly impacted due to decreased immunity stimulated by group A streptococcal infections during the COVID-19 pandemic years. However, this theory is unsubstantiated at this time.

Importantly, antimicrobial susceptibility test results from routine laboratory surveillance in England did not demonstrate any increased antibiotic resistance among S. pyogenes organisms, indicating that drug resistance is not responsible for increased virulence or spread of the organism in the current outbreak.

Expanded surveillance and research are needed to understand these outbreaks, but the pathogenesis and epidemiology of the disease provide additional context clues.

Who Is Susceptible to Scarlet Fever?

Scarlet fever can occur in people of all ages, however, the disease occurs most often in school-age and adolescent children, due to the ease of transmissibility in classrooms and daycares and lack of immunity to protective antigens of group A strep. While group A strep is not responsible for all cases of pharyngitis (strep throat) in children, it is believed to be the cause of 15-30% of all pharyngitis cases in children 5-15 years of age.

Public health cartoon, “The Wall Against Disease.”

Source: Flickr

Why Do Some People Get Scarlet Fever and Others Don’t?

Not all patients who acquire group A strep pharyngitis will develop invasive streptococcal disease. In fact, a significant proportion of school-aged children carry S. pyogenes in their upper respiratory tract without any signs or symptoms of infection. The extent to which a person will become ill due to a group A strep infection relies on the production of a type of exotoxin called bacterial superantigens (SAgs) and how the patient’s body responds to them.

In some patients, the release of group A Strep bacterial superantigens induces an immune response where uncontrollable cytokines are released from the patient’s T-cells and antigen-presenting cells. This dramatic immune response (otherwise known as a “cytokine storm”) is believed to be responsible for the manifestations of toxic shock syndrome and may include symptoms such as the constriction of blood vessels, low blood pressure, low platelet count and multi-organ failure. The superantigens SpeA, SpeC and SSA have been directly associated with scarlet fever. The development of scarlet fever depends on both the strain of Group A Strep a patient gets, and how their body responds to the infection.

Epidemiology report of the top causes of mortality in Rhode Island from 1866-1901. Scarlet Fever was the 9th most common cause of death.

Source: Wikimedia Commons

How Harmful Is Scarlet Fever?

Importantly, while the scarlet fever rash itself is not harmful, it is an indicator of Group A Strep disease, which can progress to invasive disease (i. e., necrotizing fasciitis or toxic shock syndrome) and be fatal, if left untreated. The Centers for Disease Control (CDC) estimates that in the last 5 years, 14,000 to 25,000 cases of invasive group A strep disease have occurred in the U.S. and that 1,500-3,000 people die yearly from these infections. It is imperative that data on the prevalence of disease are reported to public health agencies regularly and surveillance is performed at the public health level.

Diagnosing Group A Strep and Scarlet Fever

Streptococcus pyogenes growing on a blood agar plate.

Source: Wikimedia Commons

Typically, S. pyogenes is cultured in the clinical microbiology laboratory using solid agar media that contains sheep blood. The organism can readily hemolyze red blood cells, which results in a large zone of beta (clear) hemolysis around the colony of growth on a blood agar plate. In fact, the zone of hemolysis is so significant that it can be quite diagnostic when paired with colony morphology.

There are multiple conventional identification tests that can be used to quickly identify an organism as S. pyogenes. Any one of these tests is sufficient to identify a beta-hemolytic Streptococcus as S. pyogenes. These test methods include:

• Lancefield antigen determination: Lancefield antigen grouping serum is used to differentiate different types of Streptococci. Agglutination is observed when the organism is applied to serum with antibodies that match the presented antigen.
• Pyrrolidonyl Arylamidase (PYR) test: This test is performed using paper strips or disks that test for the presence of the enzyme pyrrolidonyl aminopeptidase, which is unique to a few gram-positive organisms, including S. pyogenes. This is a rapid colorimetric method; when the organism is applied to the disk or strip and a reagent is added, a color change will be observed.
• Bacitracin susceptibility: S. pyogenes can be differentiated from other beta-hemolytic streptococci due to its increased susceptibility to bacitracin. This test is performed by dropping a bacitracin disk on a plate with a pure culture of the organism to be tested. This test requires additional incubation, so it may be less favorable in cases where a faster turnaround time is warranted.

In addition to rapid conventional microbiology methods, S. pyogenes is readily identified using automated identification systems and MALDI-TOF. Despite its continued use to treat group A strep infections over the years, penicillin resistance has not occurred, and penicillin is still the antibiotic of choice to treat these infections. Given this, antimicrobial susceptibility testing for S. pyogenes is generally not warranted, unless a patient has a significant allergy to penicillin, and other drugs (such as macrolides) need to be tested.

WHO recommends continued surveillance and advises healthcare providers to maintain a high level of suspicion for group A strep-related diseases, as identifying and treating these infections early may prevent invasive Streptococcal disease and other serious downstream outcomes. As always, good respiratory and hand hygiene can help prevent the spread of organisms like S. pyogenes.

The emergence of yellow fever in the United States brought death and panic, but also initiated a cascade of research and discovery. In this next article, learn how research throughout the ages led to the development of vaccines and diagnostic technology that are still commonly used today.

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What is Scarlet Fever?

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By Dr. Ananya Mandal, MDReviewed by April Cashin-Garbutt, MA (Editor)

Scarlet fever is essentially a bacterial infection that leads to a typical pink-red rash. It is caused by an organism Streptococcus and is seen rarely in developed countries like United Kingdom these days.

Scarlet fever is also known as scarlatina. This is a milder form of the disease. 1-6

This patient revealed a scarlet fever rash on the volar surface of the forearm due to group A Streptococcus bacteria. The scarlet fever rash first appears as tiny red bumps on the chest and abdomen that may spread all over the body. Looking like a sunburn, it feels like a rough piece of sandpaper, and lasts about 2-5 days. Image Credit: CDC

Causes of Scarlet fever

The causative organism is toxin-producing strain of Streptococcus pyogenes (Group A beta-haemolytic streptococci or GpA BHS). Scarlet fever was common and occurred as epidemics in the 1800s. The death rate from Scarlet fever then was as high as 150/100,000.

These days with available antibiotics the severity of the infection has reduced dramatically. There has been a marked reduction in the incidence of Scarlet fever over the last 10 years.

There were 4176 notifications in England and Wales in 2009.

Scarlet fever is one of the initially viral rash associated fevers that were discovered. Others include Rubeola (measles), Rebella (German measles), Dukes’ disease (caused by coxsackie virus), Fifth’s disease or erythema infectosum and roseola infantum (caused by herpes virus, HH6).

Scarlet fever was named by Thomas Sydenham (1624-1689), the father of English medicine.

Symptoms of Scarlet fever

The disease is usually mild with characteristic symptom of a whole-body fine pink-red rash that may feel rough on touch.

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It may begin in one area and spreads soon to many parts of the body, such as the ears, neck and chest. The rash is accompanied by itching.

The patient usually presents with a flushed, red face giving the disease its name Scarlet fever. The skin around the mouth, however, appears white. The tongue may look a bit like a strawberry and is called the sign of a “strawberry tongue”.

There may be high rise of fever, general feeling of illness and swollen lymph nodes at the neck.

Symptoms usually develop one to four days after a person is infected. Scarlet fever usually follows a sore throat or a skin infection with the bacteria. Up to about 10% of streptococcal (Group A betahemolytic streptococci) sore throats will go on to cause Scarlet fever.

Is Scarlet fever contagious?

Streptococcal infection is very contagious. It is spread in tiny water droplets released in air by the infected person on coughing or sneezing. Healthy people around the infected person may become ill after inhaling the droplets with the bacteria.

Who does Scarlet fever affect?

Scarlet fever commonly affects children aged six to twelve years old. However, all age groups are susceptible to this infection. It may also affect someone who lives in a crowded environment. This is commonly seen among school children, children in a day care etc.

All children or persons exposed to the infection may not go on to develop the condition. Most children over 10 will have developed immunity to the toxins from streptococcal bacteria. This makes them resistant to the infection.

In addition, children less than two years of age are also protected from the infection due to immunity provided to them by their mothers.

Treatment of Scarlet fever

Most cases are mild and easily treatable with antibiotics, which must be taken for 10 days. Most people recover after four to five days.

Pregnant women who catch the infection usually do not have a higher risk to their babies but nearing their due dates this could be a problem and health care providers must be informed.

Complications of Scarlet fever

Complications are rare, but they can include:

• acute rheumatic fever (this may damage the heart)

• ear infections (also called otitis media)

• adenitis or abscess in the throat

• pneumonia (lung infections that may be life threatening)

• kidney damage (termed glomerulonephritis)

• meningitis (infection and inflammation of the membranes covering the brain and spinal cord)

Early treatment reduces the risk of complications.

Sources

1. http://www.nhs.uk/conditions/Scarlet-fever/Pages/Introduction.aspx
2. https://www.bbc.com/
3. http://www.patient.co.uk/doctor/Scarlet-Fever.htm
4. http://www.swsbm.com/EclecticMed/Eclectic%20Medicine_Part_Ib.pdf
5. https://www.usfca.edu/
6. https://www.windhamsd.org/

Further Reading

• All Scarlet Fever Content
• Symptoms of Scarlet Fever
• Causes of scarlet fever
• Diagnosis of scarlet fever
• Treatment of Scarlet Fever

Last Updated: May 29, 2023

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Why scarlet fever is dangerous > Rubric Medicine in Samara

Scarlet fever is an acute infectious disease of the group of streptococcal infections.

It is characterized by damage to the oropharynx, general intoxication of the body and a small rash.

The carrier of the infection is a sick person or an object that he used. The incubation period of the disease ranges from one to 10 days. It is quite common, mostly common among children.

[vrezka color=”#FFFFFF” bgcolor=”#7a97ad” image=”” image_mode=”” bgfixed=”” padding_top=”” padding_bottom=””] The incidence of scarlet fever for people under the age of 14 in the Russian Federation in recent years is 200-250 cases per 100 thousand children.[/vrezka] 90 005

In 2019, 427 cases of scarlet fever were recorded in Samara. Among the sick were 422 children under the age of 14 years. 311 kids with scarlet fever were registered in kindergartens, 78 students in schools. The indicators are below the long-term average by 7.1%. This was announced by the Deputy Head of the Department of Rospotrebnadzor for the Samara Region Rimma Galimova .

“Compared to the same period last year, the number of cases of scarlet fever decreased by 76 cases, and among children by 79. Scarlet fever, like any infectious disease, can have an epidemic spread,” she said. “But now there is no complication of the epidemiological situation.

Case history

Until the 16th century, scarlet fever was confused with other types of diseases, such as skin diseases. Before scientists discovered bacteria, the disease was considered the result of exposure to the body of toxic fumes from decay products.

It was not until 1556 that the Neapolitan physician Giovanni Ingrassias first isolated scarlet fever and described its difference from measles. Then, 100 years later, the English physician Thomas Sydenham gave a complete definition of scarlet fever, which was popularly called “purple fever”. Subsequently, various physicians studied it in clinical settings in order to expand knowledge.

In the 19th century, the disease was very common. Due to the lack of public awareness, epidemics arose. In 1923, scientists George and Gladys Dick identified the streptococcal bacterium responsible for scarlet fever. Shortly thereafter, they identified the toxin that caused the characteristic rash. This led to the development of an immunity test and a vaccine.

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Morbidity and mortality rates are low now. This has been made possible by the introduction of new drugs. The vaccine is no longer used as it has been replaced by antibiotics. Doctors found that in 1996-2007 more than 700,000 people had been ill with scarlet fever in Russia.

In recent decades, outbreaks of scarlet fever have become rare. The last one was recorded in 2018 in England. More foci of scarlet fever were observed in Vietnam, Hong Kong and China.

Symptoms

Scarlet fever can be spread from an infected person to a healthy person through touch, coughing and sneezing, and sharing utensils or things such as toys. Streptococcus can cause not only scarlet fever, but also tonsillitis and erysipelas of the skin.

It is important to pay attention to the first signs of purple fever. For example, it is typical to have a rash due to a toxin in the blood. It appears as tiny red dots that rise above the skin. These places become rough to the touch. The rash first appears on the neck, chest, and abdomen, and then spreads throughout the body. It does not affect only the nasolabial triangle.

Lesions may be small but firm. At the same time, the skin from afar looks red, as if burned. This condition lasts for six days, after which the irritation disappears. Then the patient begins peeling on the body – the size of the skin flakes does not exceed 3 mm. And on the tips of the fingers and toes, the skin can peel off in large layers.

pixabay.com

Also experienced: bright red lines under the armpits and groin, fever with chills, headache, body aches, nausea or vomiting, severe sore throat, swollen bright red tongue with plaque.

One of the constant symptoms of scarlet fever is the development of angina. In this case, the patient has a lesion of the soft palate, the tonsils increase, on the surface of which a white or yellow coating appears.

Complications

Other diseases or pathologies may occur in the background of scarlet fever. For example, a child may develop dehydration due to a high temperature. If not properly treated, scarlet fever can lead to inflammation of the paranasal sinuses or a middle ear infection.

If the disease is not treated at all, the patient may develop pneumonia or meningitis. One of the most unpleasant and severe complications of scarlet fever is rheumatoid arthritis – damage to large joints. These also include post-streptococcal endocarditis – inflammation of the inner lining of the heart, which can provoke an acquired defect.

Timely antibiotic therapy reduces the risk of scarlet fever complications to almost zero. It is necessary to take medicines no later than the ninth day of illness. Before this, you should definitely consult a doctor who, after the examination, will prescribe suitable drugs. Usually the effect of antibiotics occurs in the first 12-48 hours, and after three to four days the patient looks completely healthy.

Relieve pain

Usually, sick children are given bed rest for a week, as well as a special vitamin diet and plenty of fluids. Doctors offer parents to follow some recommendations. For example, give your child warm liquids (soup, tea, cocoa, or milk) as often as possible. Sometimes, on the contrary, cool drinks bring relief from a sore throat.

pixabay.com

You can turn on a humidifier in your child’s room. This will reduce dryness in the throat and relieve pain. Strict bed rest can not be observed if the child feels well.

According to international recommendations, children who have suffered from scarlet fever can return to school or kindergarten immediately after the temperature returns to normal, that is, on the second or third day. However, they must continue to take the antibiotic. However, the Russian pediatrician will be guided by the 21-day rule and will discharge the child no earlier than three weeks from the onset of the disease.

How not to get sick?

Since scarlet fever can be transmitted in various ways, the simple rules of prevention should not be neglected. For example, doctors advise avoiding contact with relatives or acquaintances of the sick, washing the child’s hands more often after kindergarten or school. Don’t let your child eat with someone else’s spoon or drink from someone else’s mug.

In order not to get infected in public places, it is necessary to wear protective medical masks and it is advisable to wash your nose with antiseptic solutions.

If the patient is at your home, then you need to provide him with separate dishes, a towel, a toothbrush. They need to be stored and washed separately from the things of the rest of the family. It is necessary to carry out wet cleaning of the premises and daily disinfection, on the day of recovery – the final disinfection.

In the kindergarten and in the first two grades of the school, if a patient with scarlet fever is detected, quarantine is announced.

[box type=”info” align=”” class=”” width=””]In 2018, Samara recorded an excess of the long-term average incidence of scarlet fever by 544 cases. There was another outbreak in 2014, an increase of 856.[/box]

Cover photo: pixabay.com

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Increasing incidence of scarlet fever and invasive group A streptococcal infection – multi-country data

Overview of the situation

As of 8 December 2022, at least five Member States in the European Region have notified WHO of an increase in the incidence of group A invasive streptococcal infection (iGAS) and a number of cases of scarlet fever. In some of these countries, there has also been an increase in the number of deaths caused by iSHA infection. The main contingent of the diseased are children under the age of 10 years.

Group A streptococcal (GAS) infection usually causes mild illnesses such as tonsillitis, pharyngitis, impetigo, subcutaneous cellulitis, and scarlet fever. However, in rare cases, invasive forms of GAS infection develop, which can lead to life-threatening conditions.

The observed increase in incidence may be indicative of an early onset of the GAS season, along with increased circulation of respiratory viruses and a potential increase in viral co-infection, which increases the risk of developing invasive forms of GAS infection. This is happening against the background of more active socialization of the population after a period of reduced circulation of GAS infections during the COVID-19 pandemic.

Given the moderate increase in the number of cases of iGAS infection, the endemic nature of GAS infection, there is no data on the identification of a new type of gene sequence emm , as well as information on increasing infection resistance to antibiotics, WHO considers that the risk of iSHA infections in the general population is currently low.

iSHA case data

France, Ireland, the Netherlands, Sweden and the United Kingdom of Great Britain and Northern Ireland, predominantly in children under 10 years of age, saw an increase in cases of invasive group A streptococcal infection and scarlet fever during 2022. This growth was especially noticeable in the second half of the year.

In France, since mid-November 2022, physicians have been notifying the French National Public Health Agency (NAPH) and the regional health agencies (RAS) of an unusual increase in the number of iSHA infections and the discovery of foci of cluster morbidity. Some cases of illness in children ended in death. On December 8, the NAHA published an update on the operational summary reporting an increase in the number of cases of iSHA infection since the beginning of 2022 in various regions of France (Occitania, Auvergne-Rhone-Alpes, Neu-Aquitaine), mainly among children under the age of 10 years. Since September 2022, the National Health Organization has also recorded an increase in the number of cases of scarlet fever registered in outpatient facilities in the country.

On December 6th, the Center for Health Surveillance (CHOH) Ireland reported an increase in the number of iSHA infections in the country since the beginning of October. As of December 8, in 2022, CNHC registered 57 cases of iSHA infection, including 15 cases in children under 10 years of age. These 57 cases included 23 cases of iHaS infection that had been identified since October 2022, while 11 cases were reported during the same period in 2019 (before the COVID-19 pandemic).

The Dutch National Institute for Public Health and the Environment (NIHM) has detected an increase in iHaS infections among children since March 2022. Data from March to July 2022 indicate an increase in iHaS infections due to various known types of gene sequences emm (the gene encoding the M protein which is a virulence factor for many Streptococcus pyogenes serotypes). This growth is still not decreasing. There have been cases of co-infection with varicella-zoster and respiratory viruses.

In Sweden, since October 2022, there has been an increase in cases of iSHA infection in children under 10 years of age compared to the same period before the COVID-19 pandemic. Of the 93 cases registered from the beginning of October to December 7, 16 (17.2%) cases were among children under the age of 10 years. Between October and December 2018, seven cases of iGA infection were reported in this age group, and in 2019g. – 10 cases. According to the Swedish Public Health Agency, 220 cases of iSHA infection were reported between July 1, 2021 and June 30, 2022, compared with 173 cases reported in the previous 2020-2021 season. The largest number of cases of iHAS infection since its inclusion in 2004 as a notifiable disease in Sweden until the coronavirus pandemic was recorded in 2018–2019. (794 cases (incidence 7.8 per 100,000)) and in 2017-2018. (800 cases (incidence 7.9per 100,000)).

Following an unusually high incidence of scarlet fever in England during the summer months and a decline in August 2022, reported cases have risen again between mid-September and early December, according to the United Kingdom’s Health and Safety Agency, and remain above levels normally seen at this time of year. From week 37 to week 46 of the current year period (2022-2023), 4622 cases of scarlet fever were reported, including 851 cases detected in week 46. For comparison, in the previous five years in the same period (from the 37th to the 46th week) an average of 1294 cases (with a range of values ​​from 258 to 2008). As expected, several outbreaks of scarlet fever were detected in kindergartens and schools, in some cases against the background of simultaneous circulation of respiratory viruses. Similarly, during the summer months of 2022, an unusually large number of cases of iGA infection were detected, and the number of iPA case notifications in all age groups is now higher than the values ​​reported in the last five years (an average of 248 notifications per year, with a range of values ​​from 142 to 357). As of December 8, according to laboratory surveillance data, 509cases of iSHA infection, with the highest weekly number of cases recorded at week 46 (the week beginning November 14) with 73 cases. As of 8 December 2022, during the current season, UK authorities have reported 13 deaths in England in children under 15 years of age within seven days of being diagnosed with iHAS. For comparison, for the same period 2017-2018. (before the COVID-19 pandemic) there were four deaths. Antimicrobial susceptibility testing results from routine laboratory monitoring in the United Kingdom showed no increase in antibiotic resistance. In addition, in the course of laboratory studies, no new types of gene sequences were identified emm .

Epidemiology of group A streptococci

The bacteria Streptococcus pyogenes , also known as group A streptococci, are a group of Gram-positive bacteria that can be present in the larynx or on human skin surfaces; More than 500,000 people die from this infection worldwide each year.

Transmission occurs through close contact with an infected person through coughing, sneezing or contact with damaged tissues.

GAS infection usually causes mild illnesses such as tonsillitis, pharyngitis, impetigo, subcutaneous phlegmon, and scarlet fever.