Abstract
Background: After decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes. Methods: In this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed. Findings: Data were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23–3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notifcation since 1967. The median age of cases in 2014 was 4 years (IQR 3–7) with an incidence of 186 per 100 000 children under age 10 years. All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation. Interpretation: England is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority. Funding: None.
| Original language | English |
|---|---|
| Pages (from-to) | 180-187 |
| Number of pages | 8 |
| Journal | The Lancet Infectious Diseases |
| Volume | 18 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2018 |
Bibliographical note
Funding Information:Acknowledgments We extend our thanks to all health-care professionals who notified cases of scarlet fever during this period of study, public health microbiologists who submitted strains to the national reference laboratory and TPP software, and participating SystmOne GP practices submitting data to the Public Health England syndromic surveillance system. Additionally, we acknowledge the excellent work of Health Protection Teams in management of cases and outbreaks, the expert data management support provided by Nick Hinton, technical support provided by Juliana de Macedo Coelho, and the oversight and guidance provided by the incident Management Team. Hospital Episode Statistics 2016 were re-used with the permission of National Health Service Digital. All rights reserved. Data derived from the Health and Safety Executive National Population Database, supplied under licence. This Article contains Ordnance Survey, Royal Mail, and National Statistics data, provided under copyright. The research was supported by the National Institute for Health Research (NIHR) Health Protection Research Units in Respiratory Infection and Healthcare-Associated Infection & Antimicrobial Resistance at Imperial College, London, in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.
Funding Information:
We extend our thanks to all health-care professionals who notified cases of scarlet fever during this period of study, public health microbiologists who submitted strains to the national reference laboratory and TPP software, and participating SystmOne GP practices submitting data to the Public Health England syndromic surveillance system. Additionally, we acknowledge the excellent work of Health Protection Teams in management of cases and outbreaks, the expert data management support provided by Nick Hinton, technical support provided by Juliana de Macedo Coelho, and the oversight and guidance provided by the incident Management Team. Hospital Episode Statistics 2016 were re-used with the permission of National Health Service Digital. All rights reserved. Data derived from the Health and Safety Executive National Population Database, supplied under licence. This Article contains Ordnance Survey, Royal Mail, and National Statistics data, provided under copyright. The research was supported by the National Institute for Health Research (NIHR) Health Protection Research Units in Respiratory Infection and Healthcare-Associated Infection & Antimicrobial Resistance at Imperial College, London, in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, the Department of Health, or Public Health England.
Publisher Copyright:
© 2018 Elsevier Ltd
