Scarlet Fever

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Causative agent

Scarlet fever is a bacterial infection caused by Group A Streptococcus.

Clinical features

Scarlet fever primarily affects children. Early symptoms often include sore throat, fever, headache, nausea and vomiting. The tongue may have a distinctive "strawberry-like" (red and bumpy) appearance. A rash with a "sandpaper" texture would commonly appear on the neck, underarm and groin area on the first or second day of illness. Over time, it would spread over the body. It usually subsides in about one week and is followed by skin peeling over fingertips, toes and groin areas.

Scarlet fever is sometimes complicated with middle ear infection, throat abscess, pneumonia, meningitis, bone or joint problems, damage to kidneys, liver and heart, and rarely toxic shock syndrome.

Mode of transmission

The bacteria are present in the mouth, throat and nose of the infected person. They are transmitted through either respiratory droplets or direct contact with infected respiratory secretions.

Incubation period

The incubation period of scarlet fever is usually 2 to 5 days.

Management

Scarlet fever can be effectively treated with antibiotics. If symptoms of scarlet fever develop, consult a doctor promptly and take antibiotics according to doctor’s advice. Symptoms may be relieved by concomitant use of fever-lowering medications, more rest and replenishment of fluids.

Prevention

Currently, there is no vaccine available against scarlet fever. Members of public are advised to reduce their chance of getting infection by adopting the following measures:

1. Maintain good personal hygiene

• Perform hand hygiene frequently, especially before touching the mouth, nose or eyes; after touching public installations such as handrails or door knobs; or when hands are contaminated by respiratory secretion after coughing or sneezing.
• Wash hands with liquid soap and water, and rub for at least 20 seconds. Then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, hand hygiene with 70 to 80% alcohol-based handrub is an effective alternative.
• Cover the mouth and nose with tissue paper when sneezing or coughing. Dispose of soiled tissues into a lidded rubbish bin, then wash hands thoroughly.
• Avoid sharing personal items e.g. eating utensils and towels.
• When having respiratory symptoms, wear a surgical mask, refrain from going to work or school, avoid going to crowded places and seek medical advice promptly.
• Children with scarlet fever should refrain from attending school or child care setting until fever has subsided and they have been treated with antibiotics for at least 24 hours.

2. Maintain good environmental hygiene

• Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing 1 part of 5.25% bleach with 99 parts of water), leave for 15-30 minutes, and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
• Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing 1 part of 5.25% bleach with 49 parts of water), leave for 15-30 minutes and then rinse with water and keep dry. For metallic surface, disinfect with 70% alcohol.
• Maintain good indoor ventilation. Avoid going to crowded or poorly ventilated public places; high-risk individuals may consider putting on surgical masks while in such places.

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