Epidemiology

Following a prolonged decline in the prevalence of scarlet fever since the late 19th century, outbreaks have re-emerged from around 2011 in mainland China, Hong Kong, South Korea, Taiwan, Singapore, and Vietnam, and from around 2014 in the UK and other European countries.[8][9] In England, the incidence of scarlet fever tripled in 2014 compared with 2013.[5] The median age of cases in 2014 was 4 years old and outbreaks were common in nurseries and schools. Over 19,000 cases were reported in England in 2016.[5]

These outbreaks have been associated with low mortality, unlike in previously documented epidemics in the 19th and early 20th centuries.[9] However, it is unclear whether this difference in outcome is due to Streptococcus pyogenes (group A streptococcus [GAS]) strain variation, modern diagnosis and patient care, better sanitation, widespread use of antibiotics, or other factors.[9] Although the mortality rate is low, a resurgence in scarlet fever outbreaks has resulted in increased hospital admissions.[5][9]

Scarlet fever can occur at any age but mainly affects children ages 1-10 years, and it is most common in children ages 3-6 years. Scarlet fever is uncommon in children <1 year old and in adults.[5][6][7] GAS infection is responsible for about 15% to 30% of pharyngitis episodes in children, and for around 5% to 15% of pharyngitis infections in adults.[2] It is estimated that scarlet fever develops in about 10% of patients with GAS pharyngitis.

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