Clinical and epidemiological characteristics of scarlat fever in children

In recent years, there has been an increase in the incidence of scarlet fever in the world, especially in urban areas with higher population density and more developed transport infrastructure.
Objective: to study the clinical and epidemiological features of modern scarlet fever in children in St. Petersburg to assess the development trends of the epidemic process and the effectiveness of anti-epidemic measures.
Materials and methods: a retrospective analysis of the medical records of a children’s clinic for 2015-2023 was carried out. The diagnosis was established on the basis of clinical data and laboratory examination results: sowing of discharge from the pharynx for group A streptococcus (GAS), determination of group-specific antigens of GAS in discharge from the pharynx using a commercial test system.
Results: until 2018, the situation with the incidence of scarlet fever in the observed children remained stable with a downward trend. In 2019, another increase in the incidence began. The COVID-19 pandemic interrupted the negative trend, but after the lifting of restrictive measures in 2023, the incidence rate continued to increase. Over the entire multiyear period, the number of cases in foci was limited to 1-3 cases, and the duration of outbreaks did not exceed 1-2 months. Even during the lockdown, the characteristic winter-spring seasonality of scarlet fever remained. However, in 2023, an off-season peak in incidence was noted (March-May) with the formation of 23 foci in the service area of the children’s clinic, 18 of which were observed in preschool organizations. 91.2% of outpatient children suffered from mild scarlet fever, 8.8% – in a moderate form.
Conclusion: the epidemiology of scarlet fever has not changed significantly in the last decade. However, as the experience of the COVID-19 pandemic has shown, strict restrictive measures can significantly affect the incidence rate.

1. Basetti S, Hodgson, J, Rawson T M, Majeed A. Scarlet fever: a guide for general practitioners. London J Prim Care (Abingdon). 2017; 9(5):77-79. doi: 10.1080/17571472.2017.1365677

2. Davies MR, Holden MT, Coupland P, Chen JH, Venturiniet C et al. Emergence of scarlet fever Streptococcus pyogenes emm12 clones in Hong Kong is associated with toxin acquisition and multidrug resistance. Nat. Genet. 2015; 47:84–87. doi: 10.1038/ng.3147

3. Park DW, Kim S-H, Park JuW, Kim M-Ji, Choet SJu et al. Incidence and characteristics of scarlet fever, South Korea, 2008–2015. Emerg. Infect. Dis. 2017; 23:658–661. doi: 10.3201/eid2304.160773

4. Yung CF, Thoon KC. A 12-year outbreak of scarlet fever in Singapore. Lancet Infect. Dis. 2018; 18:942. doi: 10.1016/S1473-3099(18)30464-X.

5. Turner CE, Pyzio M, Song B, Lamagni T, Meltzer M, et al. Scarlet fever upsurge in England and molecular-genetic analysis in North-West London, 2014. Emerg. Infect. Dis. 2016; 22:1075–1078. doi: 10.3201/eid2206.151726.

6. Aksenova A.V. Current epidemiological aspects of streptococcal and poststreptococcal diseases in the Russian Federation / A.V. Aksenova [i dr.] // Klinicist. – 2020. – Т.14, No 1–2. – С.14–23 (in Russian).

7. Chen H, Chen Y, Sun B, Wen L, An X. Epidemiological study of scarlet fever in Shenyang, China. BMC Infect Dis. 2019; 19(1):1074

8. Brouwer S, Lacey JA, You Yu, Davies MR, Walker MJ. Scarlet fever changes its spots. Lancet Infect Dis. 2019; 19(11):1154-1155. doi: 10.1016/S1473-3099(19)30494-3

9. Turner C.E., Holden M.T., Blane B., Horner C., Peacock S.J., Sriskandan S. The emergence of successful Streptococcus pyogenes lineages through convergent pathways of capsule loss and recombination directing high toxin expression. mBio 2019; 10(6): e02521-19. doi: 10.1128/mBio.02521-19

10. Musser J.M., Beres S.B., Zhu L., Olsen R.J., Vuopio J. et al. Reduced in vitro susceptibility of Streptococcus pyogenes to β-lactam antibiotics associated with mutations in the pbp2x gene is geographically widespread. J. Clin. Microbiol. 2020; 58: e01993-19. doi: 10.1128/JCM.01993-19

11. Lamagni T., Guy R., Chand M., Henderson K.L., Chalker V. et al. Resurgence of scarlet fever in England, 2014-16: a population-based surveillance study Lancet Infect Dis. 2018; 18:180-187. doi: 10.1016/S1473-3099(17)30693-X

12. Chalker V., Jironkin A., Coelho J., et al. Genome analysis following a national increase in Scarlet Fever in England 2014. BMC Genomics. 2017; 10(18):224. https://doi.org/10.1186/s12864-017-3603-z

13. Li Y, Rivers J, Mathis S, Li Zh, McGee L. et al. Continued increase of erythromycin nonsusceptibility and clindamycin nonsusceptibility among invasive Group A streptococci driven by genomic clusters, USA, 2018–2019. Clin. Infect. Dis. 2023; 76: e1266–e1269. doi: 10.1093/cid/ciac468

14. Vsemirnaya organizaciya zdravooxraneniya: Rost chisla sluchaev skarlatiny` i invazivnoj streptokokkovoj infekcii gruppy` A – danny`e po neskol`kim stranam. [update 2022 December 15; cited 2024 Dec.11] Available from: https://www.who.int/ru/emergencies/disease-outbreak-news/item/2022-DON429 (in Russian)

15. Glushkova E.V., Brazhnikov A.Yu., Krasnova S.V., Glazovskaya L.S., Savkina A.A., Nikitin N.V., Korshunov V.A., Briko N.I. Clinical and Epidemiological Characteristics of Scarlet Fever in Russia. Epidemiology and Vaccinal Prevention. 2023; 22(3):14-25. https://doi.org/10.31631/2073-3046-2023-22-3-14-25 (In Russian)

16. Chernova T.M., Ivanov D.О., Pavlova E.B., Timchenko V.N., Barakina E.V. et al. The impact of the COVID-19 pandemic on infectious morbidity in children in a metropolis. Children Infections. 2023; 22(2):5-11. https://doi.org/10.22627/2072-8107-2023-22-2-5-11(in Russian)

17. Venkatesan P. Rise in group A streptococcal infections in England. Lancet Respir Med. 2023;11(2): e16. doi: 10.1016/S2213-2600(22)00507-0

18. Maslyaninova A.E. E`pidemiologicheskie aspekty` skarlatiny` u detej doshkol`nogo vozrasta /A.E. Maslyaninova [i dr.] // Mezhdunarodny`j nauchno-issledovatel`skij zhurnal. – 2024. – T.149, No 11. [cited 2024 Dec.11] Available from: https://doi.org/10.60797/IRJ.2024.149.86 (in Russian)

19. Pavlova N.V. Kliniko-e`pidemiologicheskaya xarakteristika streptokokkovoj infekcii (skarlatiny`, anginy`) u detej v sovremenny`x usloviyax: avtoreferat dis. ... kandidata medicinskix nauk / N.V. Pavlova. – SPb, 2011. – 22 s. (in Russian)

20. Prinzi А. Scarlet Fever: A Deadly History and How it Prevails. American Society for Microbiology. 2023. https://asm.org/articles/2023/january/scarlet-fever-a-deadly-history-andhow-it-prevails

21. Hedin К., Thorning S, van Driel ML. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2023; 11(11): CD004406. doi: 10.1002/14651858.CD004406.pub6

22. Timchenko V.N., Pavlova E.B., Mixajlov I.B., Xmilevskaya S.A. Diagnostika i lechenie detskix infekcij (spravochnik). SPb: «Izdatel`stvo «SpeczLit». 2020. 476 s. (in Russian)

23. Vekemans J., Gouvea-Reis F., Kim J.H., Excler J-L., Smeesters P.R. et al. The path to Group A Streptococcus vaccines: World Health Organization research and development technology roadmap and preferred product characteristics. Clin. Infect. Dis. 2019; 69(5): 877-883. doi: 10.1093/cid/ciy1143

24. Aslam S., Ashfaq А.U., Zia T., Aslam N., Alrumaihi F. et al. Proteome based mapping and reverse vaccinology techniques to contrive multi-epitope based subunit vaccine (MEBSV) against Streptococcus pyogenes. Infect Genet Evol. 2022; 100: 105259. https://doi.org/10.1016/j.meegid.2022.105259

25. Fan J., Toth I., Stephenson R.J. Recent Scientific Advancements towards a Vaccine against Group A Streptococcus. Vaccines (Basel). 2024; 12(3): 272. doi: 10.3390/vaccines12030272