Scarlet fever cases rocket to the highest levels since the 1960s



Scarlet fever cases have rocketed to the highest numbers since the 1960s, new figures reveal.

Since mid-September last year, at least 11,981 cases of the bacterial infection have been reported, which is nearly triple the average 4,480 incidences over the past few winters, according to health officials in England.

Although cases have surged in recent months, scarlet fever has been on the rise since 2013, when as few as three people per 100,000 became infected to 33, more than 10 times as many, in 2016.

Cases are expected to rise over the coming weeks, with the bacteria being most active during March and April.  

The exact cause behind such an extortionate increase is unclear, however, experts have previously blamed a fall in living standards or a super drug-resistant bacteria, as well as cases coming over from outbreaks in Asia.

Scarlet fever, which typically affects those under 10, was a major cause of childhood death during the Victorian era, when hygiene was poor, and can lead to life-threatening pneumonia or sepsis if antibiotic treatment is delayed. 

Dr Theresa Lamagni, head of streptococcal surveillance at Public Health England (PHE), who believe cases are merely rising due to improved awareness, said last November: ‘Whilst rates are nowhere near those seen in the early 1900s, the magnitude of the recent upsurge is greater than any documented in the last century.’ 

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, is urging parents to seek medical attention if their child is showing symptoms, which can include a blotchy rash, red face and white-coated tongue.

Scarlet fever cases have rocketed to the highest levels since the 1960s, figures reveal (stock)

Scarlet fever cases have rocketed to the highest levels since the 1960s, figures reveal (stock)

What is scarlet fever and what are the symptoms to look out for?

Scarlet fever is a bacterial illness that mainly affects children. It causes a distinctive pink-red rash.

The illness is caused by Streptococcus pyogenes bacteria, which are found on the skin and in the throat.

First symptoms of scarlet fever include a sore throat and fever which may be accompanied by a headache, nausea and vomiting.

Between 12 to 48 hours after this, a characteristic fine, sandpapery rash develops, often appearing first on the chest or stomach.

Other symptoms include a white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue).

Cases are more common in children although adults of all ages can also develop scarlet fever.

Individuals who think they or their child may have scarlet fever should consult their GP.

Source: NHS Choices 

Changing scarlet fever levels through the years

According to PHE, there was a sharp decline in scarlet-fever cases and fatalities throughout the 1900s. 

Between 1999 and 2013, approximately 3-to-8 people became infected per 100,000.

Yet, a sharp increase in incidences took place in 2015, with a total of 15,637 reported incidences.

Analysis of GP data also showed 26,500 consultations for scarlet fever in 2014; twice that of 2013, according to figures published in The Lancet.

In one week alone in January-February 2015, 1,075 infections occurred at a rate of 27 per 100,000 – three times that of the previous year.

Rates continued to rise in the following years with 17,696 cases in 2015; a rate of nearly 31 per 100,000.

This rose to 33 per 100,000 in 2016, which was the highest incidence since 1967. 

Why are cases on the up?

Health officials remain unclear as to why scarlet fever has suddenly returned and blame ‘long-term natural cycles’.

Yet researchers in the US, where cases are also on the rise, have linked it to a super-resistant, aggressive strain of bacteria.

WHAT ARE THE ORIGINS OF SCARLET FEVER?

According to certain scientists of ancient diseases, the Greek founder of Western medicine Hippocrates may have described scarlet-fever like symptoms as far back as the 4th century BCE.

It was first officially identified in 1953 when the Italian doctor Giovanni Ingrassia named it ‘rossalia’ .

The name scarlet fever was introduced by the British doctor Thomas Sydenham in 1676. 

At this time, scarlet fever was considered a mild disease due to its rarity, particularly in comparison to plagues.

Yet, the Industrial Revolution of around the 1820s in western Europe and the US caused population booms that led to overcrowded cities and poor hygiene.

Such conditions caused scarlet fever to thrive, with fatalities rising in the UK from two per sent of cases in the late 18th century to 15 per cent in 1834. 

Squalid living conditions caused the disease to occur in cycling epidemics that did not affect rural areas. 

During the 1850s, Charles Darwin lost two children to the disease, which is also believed to have caused the American author Helen Keller to lose her sight and hearing.

A push for public health and urban cleanliness during the end of the 19th century is thought to have caused scarlet fever cases to tail off. 

Yet, with numbers rising steadily since 2013, experts fear poor nutrition and a fall in living standards may encourage the resurgence of this Victoria-era disease. 

This theory has repeatedly been ruled out by PHE, which claims to have not found any evidence supporting it despite rigorous laboratory testing.

PHE insists cases appear to be on the rise due to greater reporting and awareness. 

Outbreak in Asia

From the beginning of 2017 to April, there were around 780 scarlet fever cases in Hong Kong, with 1,100 incidences the previous year.

More than 67,000 suffered in China in 2016.

In South Korea, cases increased from 0.3 sufferers per 100,000 people in 2008 to 13.7 per 100,000 in 2015.

Although it is unclear what is causing the scarlet fever outbreaks, incidence is typically higher during winter and spring, and therefore the increasing number of sufferers may be due to climate change. 

What causes scarlet fever?

Scarlet fever is caused by the bacteria group A streptococcus and spread via coughs and sneezes or touching contaminated objects.

In most cases the infection clears up by itself, however, GPs may prescribe penicillin if symptoms are particularly severe and there is a risk of complications.

Dr Lamagni added: ‘It’s not uncommon to see more cases of scarlet fever during winter and spring.

‘Although the rise in cases seen last week is of concern, scarlet fever is not a serious illness and can be treated with antibiotics to reduce the risk of complications and spread to others.

‘We are monitoring the situation closely and remind parents to be aware of the symptoms of scarlet fever and to contact their GP for assessment if they think their child might have it.’ 

There is no vaccine for scarlet fever. Prevention focuses on hand washing, not sharing personal items and staying away from infected people. 

Other common Victorian diseases that were thought to have become things of the past but are now making a comeback include gout and syphilis.

Scarlet fever is not usually serious  

Despite concerns, Dr Nick Phin, deputy director at PHE, said: ‘It’s not uncommon to see a rise in cases of scarlet fever at this time of year.

‘Scarlet fever is not usually a serious illness and can be treated with antibiotics to reduce the risk of complications and spread to others. 

‘We are monitoring the situation closely and remind parents to be aware of the symptoms of scarlet fever and to contact their GP for assessment if they think their child might have it.

‘Whilst there has been a notable increase in scarlet fever cases when compared to last season, greater awareness and improved reporting practices may have contributed to this increase.’ 

ARE VICTORIA-ERA DISEASES ON THE RISE?

Poor lifestyles are causing a surge of diseases linked to the Victorian era in the UK, experts warned in March 2017.

A fall in living standards and growing financial inequality are thought to be behind a rise in cases of rickets, gout, syphilis and scarlet fever.

Rickets 

Rickets was made famous by Tiny Tim in Charles Dickens' A Christmas Carol

Rickets was made famous by Tiny Tim in Charles Dickens’ A Christmas Carol

Rickets, made famous by Tiny Tim in Charles Dickens’ A Christmas Carol, has increased by 39 per cent between 2009 and 2010.

The disease, which can be caused by a vitamin D deficiency, leaves sufferers with brittle bones and skeletal deformities.

Despite being common in 19th century Britain, it was all but wiped out due to ongoing improvements in nutrition.

It is thought that a fear of contracting skin cancer could be making parents overly cautious about sun exposure, putting youngsters at risk of the condition.

As well as sun exposure, vitamin D can obtained by eating foods such as oily fish, egg yolks and liver.

In January 2017, a think-tank warned rising inflation means poor families are unable to afford nutritious foods to prevent the onslaught of the disease.

Gout 

Cases of gout increased by 41 per cent between 2009 and 10, from 6,908 to 9,708, The Sun reports.

The form of arthritis, caused by a build-up of uric acid, a waste product of the body, famously afflicted Henry VIII and was rife in the Victorian era.

An ‘obesity epidemic’ and ageing population is behind the rise in gout in recent times, according to the UK Gout Society.

Syphilis 

The rising numbers of people having unprotected sex has been blamed for an increase in syphilis.

Once a death sentence, the vast majority of those infected today are curable via penicillin injections.

Figures for the sexually transmitted infection have nearly doubled in the past eight years, from 2,646 to 5,217, according to Public Health England.

Scarlet fever, which causes a rash, jumped by 198 per cent in a year (stock)

Scarlet fever, which causes a rash, jumped by 198 per cent in a year (stock)

Scarlet fever 

Cases of scarlet fever also jumped by 198 per cent between 2009 and 2010, data shows.

The highly contagious disease causes a sore throat, fever and rash, which can occasionally lead to pneumonia if not treated promptly.

Although fatal in the Victorian era, the disease is restricted to no more than unpleasant symptoms if treated early.

Symptoms include a blotchy rash, red face and white-coated tongue (stock)

Symptoms include a blotchy rash, red face and white-coated tongue (stock)

Measles cases rose by 400% in 2017  

This comes after figures released last month revealed the number of measles cases in Europe rose by 400 per cent in 2017 compared to the previous year.

The life-threatening infection affected 21,315 people last year, resulting in 35 fatalities, the figures add. This comes after a record low of just 5,273 incidences in 2016.

Dr Zsuzsanna Jakab, regional director for Europe at the World Health Organization (WHO), said: ‘Every new person affected by measles in Europe reminds us that unvaccinated children and adults, regardless of where they live, remain at risk of catching the disease and spreading it to others who may not be able to get vaccinated.’

Poor vaccination rates are thought to have led to epidemics in Romania, Italy and Ukraine. 

To prevent an outbreak, 95 per cent of the population should be immunised.

Yet, in the UK, only 91.9 per cent of children were vaccinated against measles between 2015 and 2016 compared to 94.2 per cent in 2014-to-2015 and 94.3 per cent in 2013-to-2014, according to NHS immunisation statistics.

The WHO claims people’s fear of jabs, means many, particularly young children, are unprotected.

This fear could be attributed to disgraced gastroenterologist Andrew Wakefield’s theory in 1995 that the measles, mumps and rubella (MMR) vaccine is linked to bowel disease and autism. His controversial views have since been widely discredited. 



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