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Friday, 20 March 2015

Why a return of scarlet fever?

Medical authorities in England are reporting a sharp increase in scarlet fever. This disease, which tends to affect children rather than adults, was once common. Many great-grandparents can recall being admitted to “fever hospitals” when they contracted it in the 1930s and 40s. These were special isolation units set up to nurse and isolate children who were suffering from infectious diseases.
It starts with a sore throat caused by a bacterium. The infection then becomes more widespread in the body, causing the rash of scarlet fever. Scarlet fever is potentially dangerous because it can develop into rheumatic fever, a complication that can infect and permanently damage heart valves. It was named “rheumatic” because inflamed joints are often involved. In my copy of the John Bull Family Doctor (first owned Ivor J Rees, in 1933) the page that describes how to nurse a sufferer is the only one with the corner turned down. Aspirin, for the joint pain, was the only medicine available.
Both my parents had rheumatic fever and my father’s heart was so badly damaged that he died at 34. I was only four at the time so I have few memories of him. My mother-in-law also had rheumatic fever, which caused heart problems throughout her life. She was admitted to hospital with rheumatic fever as a small girl (“I couldn’t understand why my mother had left me there.”) and, while there, she contracted diphtheria as well.
In the 1950s and 60s rates of scarlet fever declined sharply, probably because antibiotics became available as a fast and effective treatment for infected throats.
People have been asking why there is a resurgence of this disease, which has been so rare in recent generations. Several possibilities occur to me:
GPs are, quite rightly, trying not to prescribe antibiotics for sore throats, saying things like "come back in 7 days if it’s not better". Most sore throats are viral and do clear up. But some bacterial sore throats might be missed as an unintended consequence of this change in GP behavior and could, in a week, develop into scarlet fever.
Children are getting the antibiotics but the bacteria are becoming resistant. The prescription does not work and the throat develops into scarlet fever.
In some areas GP services are under such pressure that parents may be having difficulty getting an appointment. Again a delay in seeing a doctor may result in a bad throat becoming scarlet fever.
Another factor may be an increase in poverty. Other bacterial diseases, notably TB, were steadily declining in the years before antibiotics were discovered. There is a link between TB and overcrowded, impoverished living conditions. Could the same apply to Scarlet Fever? For instance it may be that (due to changes to housing benefit) there is an increase in families living in bad quality, overcrowded housing. It could also be that there is an increase in families who don't have enough to eat (indicated by the growth of food banks). I remember a few years ago being quite shocked to read that rheumatic fever was not rare in New Zealand. The incidence is higher in Maoris and Pacific Islanders. These groups tend to suffer significantly more poverty and overcrowding, and worse health, than the white population. I wondered if the same picture might be found in Australia, where indigenous ethnic groups do even worse than in New Zealand and, blow me down, I was right.
It is possible that several factors are coming together to cause an upsurge in this unpleasant and potentially dangerous disease. If the incidence continues to rise, UK health officials could do worse than look to Australia and New Zealand to see what could be learned.

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