As you may be aware, there has been a national increase in Scarlet fever cases, which is also a common, and usually a mild illness caused by bacteria called Group A Strep (GAS). GAS is a common bacteria and lots of us carry it in our throats and on our skin, and it doesn’t always result in illness. However, GAS can cause a number of infections, some mild and some more serious, such as strep throat, impetigo and scarlet fever.

In very rare occasions, the GAS bacteria can get into the lungs or bloodstream and cause a more serious illness called invasive Group A Strep (iGAS). While still uncommon, there has been an increase in iGAS cases this year, particularly in children under 10, and some children have sadly died. As a parent, we know this will be worrying, but this bacterial infection is very rare.

Scarlet fever

Scarlet fever is usually a mild illness, but it is very infectious. Look out for symptoms in your child, which include a sore throat, headache, and fever, along with a fine, pinkish or red body rash with a sandpapery feel. On darker skin, the rash can be more difficult to detect visually but will have a sandpapery feel.

Contact NHS 111 or your GP if you suspect your child has scarlet fever, because early treatment of scarlet fever with antibiotics is important to reduce the risk of complications. If your child has scarlet fever, keep them at home until at least 24 hours after the start of antibiotic treatment to avoid spreading the infection to others.

What to do if your child is unwell

There are lots of viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell.

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 38°C, or is older than 3 months and has a temperature of 39°C 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

Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections.

Yours faithfully,

Ruth Hutchinson - Director of Public Health, Surrey County Council

Liz Mills - Director of Education and Lifelong Learning, Surrey County Council

Fact sheet: ways to protect your child this winter

1. Check your child is up to date with their vaccinations: vaccination is the best defence against severe illness to protect your child and also others by stopping outbreaks in nurseries and schools. Check their red book to make sure that your child is up to date with all of their routine childhood vaccines. Click on the link to see the full list of vaccines your child should have on the NHS website vaccination schedule, including the flu vaccine.

• Flu vaccinations: if your 2 or 3 year old child has not had their flu vaccine yet, please contact your GP practice to arrange one. For primary school and some secondary children who will be offered flu vaccinations in their schools in the coming weeks, please return the consent form as soon as possible. Eligible parents and carers are recommended to get the flu vaccination to protect themselves and others this winter. For more information on flu vaccination, eligibility and how to book, please visit: Flu vaccine -NHS (www.nhs.uk)

2. Teach your child how to wash their hands and cover their coughs and sneezes: The good hygiene habits that were used to slow the spread of COVID-19 are important defences against a range of other infections, including respiratory infections and stomach bugs, like norovirus. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up, or spreading, infections.

3. Learn about other common infections: there are several common infections that your child might pick up over the winter period. In most cases, these infections will be a mild illness and can be treated at home. However, in some cases they might get worse and require medical help. Common infections in children include scarlet fever, flu and Respiratory Syncytial Virus (RSV). RSV is a common winter virus which affects children under the age of two. It can be more severe in premature babies, those under 2 months and those with underlying conditions.

4. Support your child’s school or nursery by keeping them off when needed: If your child tests positive for COVID-19: if your child tests positive for COVID-19 they should stay at home for 3 days following their positive test. If they have, or subsequently develop symptoms, they should also wait until they are well. After 3 days, if they feel well and do not have a high temperature, the risk of passing the infection on to others is much lower, and they can return to nursery/school as normal. If your child has diarrhoea, vomiting or high temperature and is unwell, then they should not attend school or mix with others outside of school, until they no longer have a high temperature and are well enough to attend. If your child has mild respiratory symptoms, like a runny nose, sore throat, or slight cough but are otherwise well, they can continue to attend their school or nursery.

More information about when to keep your child away from school or nursery is available here: Is my child too ill for school? -NHS (www.nhs.uk)

For more information on how to protect your children this winter, please read: 5 ways to protect your under 5s this winter -UK Health Security Agency (blog.gov.uk)