Abstract
The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011–2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.
Highlights
The incidence of scarlet fever in England and Wales is at its highest in 50 years
We investigated whether there is an excess risk for secondary invasive group A Streptococcus (iGAS) infection in households in which a person was given a diagnosis of scarlet fever to determine whether further public health actions are required to protect contacts
A pronounced increase in the number of pairs was evident within the first 100 days after onset of scarlet fever (Figure 2): 13 pairs identified, compared with an expected 1.5 iGAS cases based on background iGAS infection rates
Summary
The incidence of scarlet fever in England and Wales is at its highest in 50 years. During 2014, England and Wales had a sharp increase in the incidence of scarlet fever, which by 2016 had reached 33.2 cases/100,000 person-years, the highest rate in almost 50 years [1,2]. An increase in disease incidence was reported from 2009 onward in Vietnam, Singapore, Hong Kong, and mainland China but has not been reported elsewhere in Europe [1,3,4,5,6,7]. We investigated whether there is an excess risk for secondary iGAS infection in households in which a person was given a diagnosis of scarlet fever to determine whether further public health actions are required to protect contacts
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