England is experiencing an unprecedented rise in scarlet fever, with rates seeing a seven-fold increase between 2011 and 2016 to reach 33.2 per 100,000 of the population.

Rates tripled between 2013 and 2014 and the number of cases (19,206) and rate in 2016 was the highest since 1967. One in 40 cases ended in hospital admission – up 97 per cent between 2013 and 2016.

Children were especially vulnerable. The median age of cases in 2014 was four years and the incidence was 186 per 100,000 children under 10 years of age (one in every 538 children). The incidence rose across England, with 620 outbreaks in 2016, mainly in schools and nurseries.

The underlying cause of the increase isn’t clear – genetic testing has ruled out a new strain that spreads more easily. Indeed, a genetically diverse range of established strains seems to be causing the infections.

Lancet Infect Dis 10.1016/S1473-3099(17)30693-X

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