Yes, scarlet fever is still very much around. It never disappeared, and cases have actually been climbing sharply in recent years. After dropping to near-zero levels by the 1940s thanks to improved sanitation and antibiotics, the disease has staged a global comeback, with more than 600,000 cases reported worldwide since 2011, representing a five-fold increase over previous levels.
How Common It Is Today
Scarlet fever remains most common in children under 10, and recent years have brought notable surges across the Northern Hemisphere. During the 2022/23 season, the UK reported 4,622 scarlet fever notifications in just a 10-week window, compared to an average of about 1,294 for the same period over the prior five years. France, Ireland, the Netherlands, and Sweden all reported similar upticks in 2022, prompting the World Health Organization to issue a formal disease outbreak notice.
The United States continues to see thousands of cases each year as well. Scarlet fever tends to peak in late winter and early spring, following the same seasonal pattern as strep throat, since the two infections are caused by the same bacterium.
Why It’s Making a Comeback
Scarlet fever is caused by group A streptococcus, the same bug behind strep throat. The difference is that in scarlet fever, the particular strain produces a toxin that triggers the characteristic rash. Scientists aren’t entirely sure why cases have surged since 2011, but the leading theories involve shifts in the circulating strains of the bacterium, making toxin-producing types more dominant. Reduced exposure to common infections during the COVID-19 pandemic may have also left children’s immune systems less primed, contributing to the sharp spike seen in 2022.
Importantly, the bacterium has not become resistant to the standard antibiotics used to treat it. The increase is about more people getting infected, not about the infection being harder to treat.
What Scarlet Fever Looks and Feels Like
Scarlet fever starts like a typical sore throat: fever, swollen tonsils, red throat, and sometimes white patches of pus on the tonsils. Lymph nodes at the front of the neck often swell. You might also notice tiny red spots on the roof of the mouth.
The hallmark rash usually shows up one to two days after the first symptoms, though it can appear up to a week later. It begins as small, flat blotches that develop into fine bumps with a distinctive sandpaper texture. The rash is often most intense in skin creases like the elbows, underarms, and groin, and there’s typically a pale ring around the mouth that stands out against the flushed face. It fades over about seven days, and the skin often peels as it resolves.
The tongue goes through its own progression. Early on it develops a whitish coating. As that clears, it turns red and bumpy, creating what doctors call a “strawberry tongue.” This combination of sandpaper rash, strawberry tongue, and sore throat is distinctive enough that a doctor can often recognize scarlet fever on sight, confirmed with a rapid strep test.
How It’s Treated
Scarlet fever responds well to basic antibiotics. The standard treatment is a 10-day course of penicillin or amoxicillin. For children or adults with a penicillin allergy, several alternatives work, including certain antibiotics in the cephalosporin family or a shorter five-day course of azithromycin.
Most children start feeling better within a day or two of starting antibiotics, but finishing the full course matters. Completing treatment clears the bacteria fully, reduces the chance of spreading it to others, and helps prevent rare but serious complications like rheumatic fever, which can damage the heart valves, or kidney inflammation.
Children are generally considered no longer contagious after 12 to 24 hours on antibiotics and can return to school once they’ve been fever-free and on medication for at least a full day. Without antibiotics, a person can remain contagious for two to three weeks even after symptoms improve.
Why It’s Less Dangerous Than It Used to Be
Scarlet fever was once one of the deadliest childhood diseases. In the 1800s, epidemics killed tens of thousands of children, and parents feared it the way later generations feared polio. The mortality rate dropped dramatically even before antibiotics arrived, likely because the dominant bacterial strains became less virulent and living conditions improved.
Today, with prompt antibiotic treatment, scarlet fever is a manageable illness. Deaths are extremely rare in countries with access to healthcare. The infection typically runs its course in about a week, the rash fades, the skin peels, and children recover fully. The main risks come from untreated cases, where the bacteria can trigger immune reactions that affect the heart, kidneys, or joints weeks after the original infection.
How It Spreads
Scarlet fever spreads the same way as strep throat: through respiratory droplets when someone coughs or sneezes, and through direct contact with mucus or saliva. Sharing cups, utensils, or towels with an infected person can transmit it. The bacteria can also live on surfaces briefly, though person-to-person contact is the primary route.
There is no vaccine for scarlet fever. Basic hygiene is the best prevention: frequent handwashing, not sharing eating utensils, and keeping sick children home until they’ve been on antibiotics for at least a day. If your child has been diagnosed, it’s worth letting their school or daycare know so other parents can watch for symptoms, since outbreaks in young children tend to cluster.
Having scarlet fever once does not guarantee immunity. The toxin that causes the rash comes in several types, so a child can get scarlet fever more than once if they encounter a different toxin-producing strain.