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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