January 29, 2001

"There is nothing we can do that is more important than ensure the health of our families and children. But it takes community involvement to promote a healthy city. Educate yourselves, your family and your friends. Promote good health by practicing preventative care." – Mayor Anthony A. Williams

On January 17, 2001, Ivan C.A. Walks, M.D., Chief Health Officer of the District of Columbia and Director of the Department of Health, held a press conference to allay public concerns about scarlet fever and to distribute information on ways to prevent the spread of this disease.

STREPTOCOCCAL INFECTION

What is a Group A streptococcal infection?
A Group A streptococcal infection is an illness caused by a bacterium that is found in the mouth, nose, and throat of an infected person. The Group A streptococcus produces a wide range of infections from sore throat, skin infection, and scarlet fever to kidney infections and rheumatic fever.

Who gets Group A streptococcal infections?
Group A streptococcal infections can occur at any age. The three to 15-year-old age group is most commonly affected.

How are Group A streptococcal infections spread?
Group A streptococcal infections are primarily spread by direct or intimate contact with carriers. Transmission of respiratory secretions may occur from hands, person-to-person contact such as kissing, or the projection of large droplets during coughing or sneezing.

What are the symptoms of a Group A streptococcal infection?
The symptoms are skin rash, fever, chills, sore throat, painful swallowing, malaise, headache, abdominal pain, nausea, and/or vomiting.

How soon do symptoms appear?
The incubation period is short, usually 1-3 days, before the appearance of symptoms.

How long is a person able to spread a Group A streptococcal infection?
It can be spread until the carrier has been treated for 24 hours.

How is a Group A streptococcal infection diagnosed?
In most cases, the disease is diagnosed through the recognition of symptoms and a throat culture.

What is the treatment?
Penicillin is the drug of choice. Antibiotic therapy is aimed at eradicating streptococci from the respiratory tract.

What can be done to prevent the spread of Group A streptococcal infections?
To prevent the spread of Group A streptococcal infections, it is important to cover one's mouth with a hand when coughing or sneezing; wash hands, if possible; reduce person-to-person contact through practical measures such as crowd reduction and proper ventilation; and promote good hand washing and other hygienic measures in the home.

SCARLET FEVER

What is scarlet fever?
Scarlet fever is a disease caused by Group A B-hemolytic streptococci. The disease is most commonly associated with a sore throat and is found in the mouth, nose, and throat of an infected person. The disease occurs most frequently in the late fall, winter, and spring in the United States, presumably because of close person-to-person contact indoors and in schools.

Who gets scarlet fever?
Scarlet fever and streptococcal sore throat can occur in people of all ages, but it is most frequent among school-aged children.

How is scarlet fever spread?
Scarlet fever usually results from direct contact with a person who has active streptococcal sore throat or through large respiratory droplets spread during coughing or sneezing.

What are the symptoms of scarlet fever?
Scarlet fever is characterized by a sandpaper-like rash. The rash appears most often on the neck, chest, in folds under the arm, elbow, and groin and on inner surfaces of the thighs. Typically, scarlet fever's rash does not involve the face, but there is flushing of the cheeks and paleness around the lips. High fever, nausea, and vomiting often accompany severe infections.

How soon after infection will symptoms appear?
Scarlet fever may occur from one to three days after exposure to an infected individual.

Does past infection with scarlet fever make a person immune?
Immunity against scarlet fever's rash develops within a week after onset of scarlet fever and is usually permanent. Second attacks of scarlet fever are rare, but may occur because three immunologic forms of toxin exist.

What is the treatment for scarlet fever?
Antibiotics such as penicillin, erythromycin, and cephalosporin are generally prescribed.

What can be done to prevent the spread of scarlet fever?
The most important means to control this disease is prompt identification and treatment of the infection. It is also important to cover one's mouth with a hand when coughing or sneezing and to wash hands, if possible. Children with streptococcal sore throat or skin infections should not return to school or day care, until 24 hours after antibiotic therapy has begun and they have no fever. Close contact with other children should be avoided.