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The UK Health Security Agency (UKHSA) has reported a significant increase in scarlet fever and invasive Group A Strep. Strep A is a bacteria that can cause a range of illnesses which are usually mild and can be treated with antibiotics. In some cases, a Strep A infection can cause scarlet fever which is generally a mild illness, but it is highly infectious.

The UKHSA advise all childcare providers to be aware of symptoms such as a sore throat, headache, and fever, along with a fine, pinkish or red body rash with a sandpapery feel.

Advice for Early Years Educators and Childcare Providers

It is important to familiarise yourself with the signs and symptoms of the infection. It is advised that children with scarlet fever, should be kept home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others. 

Schools, nurseries and other childcare settings should promptly notify their local HPT of suspected scarlet fever outbreaks. An outbreak of scarlet fever is defined as two cases of complicated/more serious scarlet fever or a case of scarlet fever where there is also flu/chicken pox in the setting. You should report it to your local health protection team (HPT) for further guidance. You can find the details of your local HPT here.

The UKHSA also urges children or nursery/school staff who refuse treatment with antibiotics to be excluded until symptoms are resolved.

Advice for Parents and Carers

Parents and carers are advised to seek medical help by calling NHS 111 or their GP if they suspect their child has scarlet fever. They should use their judgement and seek further medical assistance if they notice the child deteriorating. The Government advice is as follows:

Contact NHS 111 or your GP if:

• your child is getting worse
• your child is feeding or eating much less than normal
• your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
• your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
• your baby feels hotter than usual when you touch their back or chest or feels sweaty
• your child is very tired or irritable

Call 999 or go to A&E if:

• your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
• there are pauses when your child breathes
• your child’s skin, tongue or lips are blue
• your child is floppy and will not wake up or stay awake.

The Department for Education in England has recently published a blog with information for parents and education settings around Strep A and scarlet fever and the symptoms to be aware of. You may wish to share this link on social media or through ParentZone to ensure the parents and carers of children in your setting have access to this information.

In this document, Appendix 5, page 26 you will find a scarlet fever outbreak letter template for parents/guardians.

Infection Control Advice 

In childcare settings, infections can be spread through close contact between children and staff and through shared contact with physical surfaces such as table tops, toys, taps, and handles. 

Hand washing remains the most important step in preventing such infections. Good hand

hygiene should be enforced for all pupils and staff and a programme should be put into place that encourages children to wash their hands at the start of the school day, after using the toilet, after play, before and after eating, and at the end of the school day. It is important to ensure that liquid soap and paper towels are available at all times. Here you can find hand hygiene resources for schools and nurseries.

Children and adults should be encouraged to cover their mouth and nose with a tissue when they cough and sneeze and to wash their hands after sneezing and after using or disposing of tissues. Spitting should be discouraged.

Breaching the skin barrier provides a portal of entry for the organism, therefore children and staff should be reminded that all scrapes or wounds, especially bites, should be thoroughly cleaned and covered.