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Strep A. Guidance for parents



Two notices issued: 

DCC Advice Strep A

UK Health Protection Agency Scarlet fever




As you are aware, the increase of Strep A infections are at a 6 year high in the UK currently.  Whilst the impact of infection is usually mild, it can also be life threatening.


Should we be advised of a specific Strep A risk to the school, or if cases are reported, parents would be informed according to the guidance provided by Derby City Council or Public Health.


This has not been necessary to date.  There is no need to contact the school or staff; we would inform you of any specific concerns.

IMPORTANT:  School staff are not medical practitioners and cannot advise you on your actions.  Pleased seek medical advice from NHS 111 if you require assistance.


I enclose guidance and information  for parents to support identification of Strep A infection and actions as issued by Derby City Council / Public Health.


Guidance for Parents STREP A

Strep A- advice for parents/carers (updated by DCC)


Please read all this information


Strep A is a bacteria that causes infections such as sore throat, scarlet fever, and skin infections like impetigo. Strep A infections are seen every year, usually in the early spring, and the bacteria is spread through snot and spit.


Most Strep A infections are very mild and can be easily treated with antibiotics. In very rare cases, the bacteria can get into the bloodstream and cause an illness called invasive Group A strep (iGAS). These are the cases that have been in the news recently.


This year, we are seeing an increase in scarlet fever (caused by Strep A) earlier than we might expect. Whilst still very rare, we are also seeing an increase in invasive Group A Strep cases.


There are also several other winter bugs going around; so not all poorly children will have Strep A. Many of these other winter bugs are caused by viruses and cannot be treated with antibiotics. Most winter bugs, with coughs, sneezing, and sore throat, can be managed at home.


We have described the symptoms of scarlet fever and what you should do below.

Symptoms of scarlet fever:

  • High fever (feeling hotter than usual on the back or chest, feeling sweaty)

  • Difficulty swallowing

  • Sore swollen lymph nodes (glands)

  • Sore neck or throat

  • Headache

  • Feeling sick

  • Being sick

  • Feeling tired or unwell

  • Flushed red face, but pale around the mouth

    Followed 12-48 hours later by:

  • Small, red, widespread rash. The rash gives the skin a rough sandpaper-like feel.

  • Tongue rash has strawberry-like appearance.

  • On darker skin the rash may be more difficult to see but will still have a sandpaper-like feel.

    Please see NHS online for more information.

    Complications from scarlet fever are rare and the risks made less by antibiotic treatment. However, they can happen during or in the weeks after the infection, and can include ear infection, throat swelling, sinusitis, lung infection, meningitis, and rheumatic fever (which can affect the joints and heart)


  • What should I do if my child has these symptoms, or I am worried?

    You should contact your GP if your child has the symptoms of scarlet fever.


The GP will assess your child and decide whether they need antibiotics. If your child is prescribed antibiotics, you should make sure they take the full course.

If your child has another winter bug caused by a virus, antibiotics will not be prescribed, as they do not work on viruses.


If you think your child is seriously unwell, trust your judgement.


How can I stop the spread of infection?

You can help to stop the spread of scarlet fever and other winter bugs by asking your child to cover their nose and mouth with a tissue (or sleeve) when sneezing or coughing, put the tissue in the bin, and then wash their hands.


You should also encourage your child to wash their hands. Children should use soap and water or alcohol hand gel often, and always before eating or touching food, after using the toilet, and after coughing or sneezing.


Children should not share cutlery, towels, clothes, bedding, or baths.


These actions are important for preventing lots of different infections, please also consider getting your child the free flu vaccine. All 2- and 3-year-olds can get a free flu vaccine from the GP. Primary aged children and children in Y7, Y8 and Y9 will be offered the free flu vaccine at school. More information about the children’s free flu vaccine can be found here, information about the adult’s free flu vaccine can be found here.


If your child missed the flu vaccine at school and you would like them to have it, please contact 01283 707178 or


When should children with symptoms of scarlet fever stop coming to school, nursery, or college?

Children with scarlet fever can return to their school, nursery or college 24 hours after taking their first dose of antibiotics if they are well enough. They must not come back before starting antibiotics as they will be infectious for several weeks without treatment.


Guidance for Parents Scarlet Fever


Re: Increase in scarlet fever

We are writing to inform you of a recent [national/local] increase in notifications of scarlet fever to the UK Health Security Agency (UKHSA), above seasonal expected levels.


We would like to take this opportunity to remind you of the signs, symptoms and the actions to be taken if you think that you or your child might have scarlet fever.


Signs and symptoms of scarlet fever

Scarlet fever is a common childhood infection caused by Streptococcus pyogenes, or group A Streptococcus (GAS). It is not usually serious, but should be treated with antibiotics to reduce the risk of complications (such as pneumonia) and spread to others.


The early symptoms of scarlet fever include sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours, the characteristic red, pinhead rash develops, typically first appearing on the chest and stomach, then rapidly spreading to other parts of the body, and giving the skin a sandpaper-like texture.


The scarlet rash may be harder to spot on darker skin, although the 'sandpaper' feel should be present. Patients typically have flushed cheeks and be pale around the mouth. This may be accompanied by a bright red red ‘strawberry’ tongue.


If you think you, or your child, might have scarlet fever:

  • contact your GP or NHS 111 as soon as possible
  • make sure that you or your child take(s) the full course of any antibiotics prescribed. Although you or your child will feel better soon after starting the course of antibiotics, you must complete the course to ensure that you do not carry the bacteria in your throat after you have recovered
  • stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection


You can help stop the spread of infection through frequent hand washing and by not sharing eating utensils, clothes, bedding and towels. All contaminated tissues  should be disposed of immediately.


Invasive Group A Strep (iGAS)

The same bacteria which cause scarlet fever can also cause a range of other types of infection such as skin infections (impetigo) and sore throat. In very rare cases, the bacteria can get into the bloodstream and cause an illness called invasive group A strep (iGAS). Whilst still very uncommon, there has been an increase in iGAS cases this year, particularly in children under 10 years old. It is very rare for children with scarlet fever to develop iGAS infection.

As a parent, you should trust your own judgement.

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

Stop the spread

During periods of high incidence of scarlet fever, there may also be an increase in outbreaks in schools, nurseries and other childcare settings. Children and adults with suspected scarlet fever should stay off nursery / school / work until 24 hours after the start of appropriate antibiotic treatment. Good hygiene practice such as hand washing remains the most important step in preventing and controlling spread of infection.

Yours sincerely,


Susanne Howes

Consultant in Health Protection



NHS – Scarlet Fever

Scarlet fever: symptoms, diagnosis and treatment

Health protection in education and childcare settings

Hand hygiene resources for schools