Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019

Herdman, T., Cordery, R., Karo, B., Purba, A. K., Begum, L., Lamagni, T., Kee, C., Balasegaram, S. and Sriskandan, S. (2021) Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018-2019. BMJ Open, 11(12), e057772. (doi: 10.1136/bmjopen-2021-057772) (PMID:34952887)

[img] Text
259607.pdf - Published Version
Available under License Creative Commons Attribution.

4MB

Abstract

Objectives: In response to increasing incidence of scarlet fever and wider outbreaks of group A streptococcal infections in London, we aimed to characterise the epidemiology, symptoms, management and consequences of scarlet fever, and to identify factors associated with delayed diagnosis. Design and setting: Cross-sectional community-based study of children with scarlet fever notified to London’s three Health Protection Teams, 2018–2019. Participants: From 2575 directly invited notified cases plus invitations via parental networks at 410 schools/nurseries with notified outbreaks of confirmed/probable scarlet fever, we received 477 responses (19% of those directly invited), of which 412 met the case definition. Median age was 4 years (range <1 to 16), 48% were female, and 70% were of white ethnicity. Outcome measures: Preplanned measures included quantitative description of case demographics, symptoms, care-seeking, and clinical, social, and economic impact on cases and households. After survey completion, secondary analyses of factors associated with delayed diagnosis (by logistic regression) and consequences of delayed diagnosis (by Cox’s regression), and qualitative analysis of free text comments were added. Results: Rash was reported for 89% of cases, but followed onset of other symptoms for 71%, with a median 1-day delay. Pattern of onset varied with age: sore throat was more common at onset among children 5 years and older (OR3.1, 95% CI 1.9 to 5.0). At first consultation, for 28%, scarlet fever was not considered: in these cases, symptoms were frequently attributed to viral infection (60%, 64/106). Delay in diagnosis beyond first consultation occurred more frequently among children aged 5+ who presented with sore throat (OR 2.8 vs 5+without sore throat; 95% CI 1.3 to 5.8). Cases with delayed diagnosis took, on average, 1 day longer to return to baseline activities. Conclusions: Scarlet fever may be initially overlooked, especially among older children presenting with sore throat. Raising awareness among carers and practitioners may aid identification and timely treatment.

Item Type:Articles
Additional Information:Funding: This report was funded by Action Medical Research. It was also funded in part by the Medical Research Council (grant MR/P022669/1) and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England (grant HPRU-2012-10047).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:PURBA, Amrit
Authors: Herdman, T., Cordery, R., Karo, B., Purba, A. K., Begum, L., Lamagni, T., Kee, C., Balasegaram, S., and Sriskandan, S.
College/School:College of Medical Veterinary and Life Sciences
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Published Online:24 December 2021
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2021
First Published:First published in BMJ Open 11(12):e057772
Publisher Policy:Reproduced under a Creative Commons Licence

University Staff: Request a correction | Enlighten Editors: Update this record