Streptococcal infections and Scarlet fever are caused by Group A Streptococcus (GAS) bacteria. Although Scarlet fever was once feared, it is easily treated with antibiotics, and the vast majority of GAS infections are mild. Many people carry the GAS bacteria without it causing illness. Around 20% of children are GAS carriers.
Sadly in very rare cases, the infection can invade deeper into the body. This is called invasive Group A Streptococcus (iGAS) and can cause extremely serious illness and death.
GAS infections cause various symptoms such as sore throat, fever, chills and muscle aches.
Annual cases of Scarlet fever have been rising since around 2014, and as the numbers of GAS infections increase, so do the number of iGAS infections, but iGAS infection still remain very rare.
Adults can get Strep A and while anyone can get Scarlet Fever, it is more common in children than adults.
Members who are clinically vulnerable or clinically extremely vulnerable should discuss any concerns with their medical professional, and any recommendations reported to their employer. An occupational health referral and/or individual risk assessment may also be required.
The NHS has guidance on symptoms of GAS and when to seek help.
The Department for education in England has also provided guidance on GAS. The UK health Security Agency (UKHSA) has also issued guidance.
Governments in Scotland, Wales and Northern Ireland have also issued guidance to schools.
Schools should ensure that parents are aware of the symptoms, and what to do if they suspect their children has a GAS infection. This should include a clear instruction that children should not attend the setting whilst ill. NHS guidance is that children with scarlet fever can return 24 hours after starting antibiotics, or 48 hours after starting antibiotics with cases of Impetigo, which is also caused by GAS.
Schools should have in place an up to date risk assessment and ensure that infection control procedures are in place. GAS is primarily spread through saliva and mucus (such as droplets from coughs and sneezes) and direct skin contact. Pupils should be encouraged to adopt good respiratory hygiene (Catch it - bin it - kill it) and regularly wash hands with soap and water, or hand sanitiser if soap and water is not available. All cuts, scrapes, bites and wounds should also be cleaned and covered.
The UKHSA also advises schools that they should carry out regular cleaning throughout the day, especially hand contact surfaces with particular attention to hand touch surfaces that can be easily contaminated such as door handles, toilet flushes and taps and communal touch areas. These should ideally be cleaned using a disinfectant.
Schools should also ensure rooms are adequately ventilated whilst balancing thermal comfort.
These basic mitigations will also assist in relation to the risk of other infectious diseases such as flu, COVID-19 and norovirus.
What schools should do
Schools are being asked to follow the usual outbreak management processes as set out in UKHSA if an outbreak of scarlet fever is identified. An ‘outbreak’ is defined as 2 or more probable or confirmed cases attending the same school, nursery or other childcare setting within 10 days of each other.
Schools and nurseries should contact their local Health Protection Team if:
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They have one or more cases of chickenpox or flu in the class that has scarlet fever at the same time. This is because infection with scarlet fever and either chickenpox or flu at the same time can result in more serious illness.
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They are experiencing an outbreak of scarlet fever in a setting or class that provides care or education to children who are clinically vulnerable.
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The outbreak continues for over 2 weeks, despite taking steps to control it.
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Any child or staff member is admitted to hospital with any Group A Strep (GAS) infection (or there is a death).
Schools where outbreaks occur are additionally advised to:
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Make sure that all children and employees that are ill go home and don’t return until they are well.
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Tell parents and visitors about the cases of illness.
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Remind employees to wash their hands throughout the day. Hand washing needs to be done after changing nappies and helping children use the toilet.
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Make sure that all cuts, scrapes and wounds are cleaned and covered. This also applies to bites.
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Carry out regular cleaning throughout the day, especially hand contact surfaces. Advice may also be given to increase cleaning of areas with particular attention to hand touch surfaces that can be easily contaminated such as door handles, toilet flushes and taps and communal touch areas. These should ideally be cleaned using a disinfectant.
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Consider stopping messy play, removing hard to clean soft toys, not going on visits outside of your setting and not allowing children to share drinks
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Once cases have stopped (no new cases or illness for 10 days), do a full cleaning of buildings (including toys, carpets etc)