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What Parents Should Know About the Germs That Cause Scarlet Fever

One hundred years ago, author Margery Williams wrote the children’s book The Velveteen Rabbit. In the story, the main character, a young boy, gets sick and to decontaminate his room, all his books and toys, including the velveteen rabbit, need to be burned. What illness did he contract? Scarlet fever.

“Before antibiotics were available, scarlet fever used to be a dreaded disease and was a leading cause of death in children,” said Nathan Price, MD, a pediatric infectious disease specialist with Banner Children's. Fortunately today, scarlet fever isn’t as dangerous as it once was, and we no longer need to destroy everything a child owns to keep it from spreading.

Dr. Price filled us in on some of the details about this disease.

What is scarlet fever?

Scarlet fever is a disease caused by the bacteria Streptococcus pyogenes, also known as group A streptococcus. This is the same “strep” that causes strep throat. The germ is circulating all the time. In fact, in the winter, up to 20% of children have group A strep growing on their tonsils. But most of them don’t have any problems or symptoms and generally don’t infect other people. 

People who do get sick might develop strep throat and have a fever and sore throat. People with scarlet fever typically start with a white strawberry tongue, which may turn red after a few days. People who get scarlet fever will have those symptoms plus a red rash—that’s why the disease is called scarlet fever. The bacteria that trigger the strep infection produces a toxin that causes the rash.

“The rash can start out as red and blotchy and turn into small red bumps that cover large parts of the body. If you run your hand over the rash, it feels rough like sandpaper,” Dr. Price said.

How can you prevent scarlet fever?

There’s no vaccine for the germ that causes scarlet fever. It’s very contagious and transmitted by coughing, sneezing, talking and close contact with someone who has strep throat or scarlet fever. So, the best way to prevent it is to wash your hands often with soap and water, avoid sharing cups and utensils and stay away from people who are sick. You can get scarlet fever at any age, but children are most susceptible. 

Since the bacteria is so contagious, it’s common for the germ to infect multiple family members. But most people will only get strep throat, not scarlet fever. And, about a day (24 hours) after starting antibiotics, most people are no longer contagious. 

How is scarlet fever diagnosed and treated?

If your child has symptoms of scarlet fever, your doctor can swab their throat to check for group A strep. “Penicillin and other antibiotics can treat scarlet fever, and most people fully recover,” Dr. Price said.

Along with antibiotics, getting plenty of rest and drinking lots of water can help your child recover. Over-the-counter medication can reduce pain and fever, and lozenges or throat sprays can soothe a sore throat. (Don’t give lozenges to young children who could be at risk of choking.)

Since it’s relatively easy to diagnose and treat scarlet fever, complications are rare. It’s possible to develop an abscess in the throat or an infection in another part of the body. “The bacteria can also activate the immune system and cause problems weeks later, leading to diseases such as rheumatic fever, glomerulonephritis and arthritis that can affect the heart, kidneys and joints,” Dr. Price said.

The bottom line

A century ago, scarlet fever was a devastating childhood disease. Today, with modern diagnostic techniques and antibiotics, it’s relatively easy to identify and treat the illness. If you notice signs such as fever, sore throat and a tell-tale red rash, talk to your child’s pediatrician or reach out to an expert at Banner Health. 

If you think your child may have scarlet fever

Save your spot at an urgent care near you.
Schedule an appointment with a pediatrician.

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Children's Health Infectious Disease