Strep A and scarlet fever: Cases hit new record - the picture in England, Wales, Scotland and Northern Ireland

Strep A infections remain on the rise in the UK, with at least 30 child deaths reported so far this autumn and winter.

While the UK also saw a large outbreak in the winter of 2017/18, the situation this year is already worse across a number of measures, latest data shows. This month in England, weekly scarlet fever case numbers hit their highest levels since records began in 1982, the UK Health Security Agency (UKHSA) said.

Here is how the outbreak is developing in each of the four nations, according to information released by their respective public health agencies.

The link between Strep A and scarlet fever explained

Strep A, or Group A Streptococcus (GAS), is the name given to a type of bacteria sometimes found in the throat or on the skin. It usually causes mild illnesses such as a sore throat, but can cause other infections such as pneumonia, scarlet fever, cellulitis or impetigo. Very rarely it can cause severe illness when the bacteria get inside the bloodstream. This is called invasive Group A Streptococcal disease (iGAS) and can be deadly.

Peaks in Strep A infections are typically seen during the winter and spring months. Roughly every three to four years, the UK will see a season of high infection rates - the previous one being in 2017/18. Infection rates were unusually low in the years when coronavirus restrictions were in place.

Scarlet fever is a highly contagious infection caused by the Strep A bacteria. Symptoms include a sandpapery skin rash and a white coating on the tongue. Scarlet fever used to be a very serious infection, but thanks to antibiotics most cases these days are mild and easily treated. However, in very rare occasions, the Strep A bacteria can then get into the bloodstream and cause iGAS.

The Strep A outbreak in England

Scarlet fever infections have “increased to exceptional levels” this autumn and winter, according to the UKHSA.

There have been more scarlet fever cases in the past three months than there were in the year-long 2017/18 season, the last time the country saw high infection levels.

The UKHSA said the number of cases recorded in each of the past three weeks are all higher than in any week since records began in 1982.

The rate of iGAS infections is following a similar pattern, with higher than expected levels, particularly in recent weeks, it said. While iGAS infections are higher than usual across all age groups, they are “particularly elevated” among children under 10, the UKHSA said.

There have been 122 deaths within seven days of an iGAS diagnosis since September 12, including 25 deaths of children aged under 18.

The Strep A outbreak in Scotland

Scarlet fever is not a notifiable disease in Scotland so official figures are not collected. But laboratory confirmed upper respiratory tract Strep A infections – for example, from throat and nose samples - are far higher than in previous years.

These infection numbers are “now well beyond those seen in previous years”, according to Public Health Scotland - although it added that some of this could be due to increased testing.

However the more serious iGAS infections have been generally stable in 2022 and similar to previous years, Public Health Scotland said. It knew of seven iGAS deaths between 3 October and 25 December 2022, two of whom were in children under 10 years of age. This compares with between zero and seven deaths reported during the same time period in recent years.

The Strep A outbreak in Wales

In Wales, reports of scarlet fever remain high, with 676 suspected cases in the week ending December 25, according to the UK Health Security Agency.

Public Health Wales confirmed that since September 1 at least one child aged under 15 had died after developing iGAS but, because the number was less than five, it would not say how many. According to media reports, at least two children have died in Wales this autumn and winter.

Dr Graham Brown, Consultant in Communicable Disease Control for Public Health Wales, said: “While we understand that parents are likely to be worried, cases of invasive group A streptococcal infection (iGAS) remain rare in Wales, and children have a very low risk of contracting the disease.

“As of Wednesday 28 December 2022, Public Health Wales has been notified of fewer than five deaths in children under the age of 15 in whom iGAS was detected since 1 September 2022. We offer our deepest condolences to the family, friends and all those affected.

“Due to the risk of identification, Public Health Wales will not confirm numbers of deaths lower than five. Public Health Wales cannot comment on individual cases.”

Dr Brown said scarlet fever is usually a mild illness, especially if the condition is properly treated with antibiotics, adding: “In a very small number of cases, a Strep A infection can cause iGAS, a rare complication which usually affects fewer than 20 children in Wales each year.  Although iGAS is a worrying condition, the majority of these children will recover with proper treatment.”

The Strep A outbreak in Northern Ireland

In Northern Ireland, there have been 48 confirmed or probable iGAS infections in 2022 to date, according to its Public Health Agency (PAS). This year’s figure “does not currently appear exceptional” compared with other pre-pandemic years, it said.

However, there has been a large rise in cases this month. Monthly figures show the number of confirmed or probable iGAS cases in December so far have already hit a six-year high.

And the number of scarlet fever cases in Northern Ireland is far higher than normal, with more than 600 confirmed or probable cases reported so far this month alone. This is more than in the whole of 2018, the last year with high case numbers. PAS said this could partly be down to increased awareness among the public this year.

PAS has published no information on deaths caused by iGAS, but in December a five-year-old girl from Belfast became the ninth child in the UK to die this year according to BBC News NI.