Disease overview

Bacterial

Scarlet fever

猩红热

Evidence-backed informationEN 5/7 applicable sections · ZH 5/7 applicable sectionsUpdated Sep 3, 2026

Scarlet fever is an infection caused by toxin-producing strains of Streptococcus pyogenes, historically responsible for substantial morbidity and mortality during widespread epidemics across Europe and North America ^[1]. Following a prolonged decline throughout the twentieth century, the disease has recently re-emerged in multiple nations, most notably demonstrating a marked increase in European incidence during the post-pandemic period ^[2]^[1]. Global epidemiology continues to fluctuate as novel bacterial clones emerge, often acquiring enhanced virulence or antimicrobial resistance traits that alter disease dynamics ^[3].

Read the full clinical and epidemiological profile6

Definition

The condition represents a clinical manifestation resulting from infection with pyrogenic exotoxin-producing strains of Streptococcus pyogenes, commonly designated as Group A Streptococcus ^[1]. Pathogenesis is driven by bacterial superantigens that trigger an amplified hypersensitivity response within the host immune system ^[2]. This immunological cascade typically manifests alongside systemic symptoms and characteristic dermatological findings, distinguishing it from other febrile exanthematous processes ^[4].

Clinical features

Clinical presentation typically begins with acute onset of high fever and severe sore throat ^[2]. Patients frequently develop a distinctive sandpaper-like maculopapular rash accompanied by concurrent oral changes, often described as strawberry or raspberry tongue ^[2]. Infection with toxin-producing strains can also manifest as pharyngitis, pyoderma, or invasive disease, with potential for triggering post-infection immune sequelae including acute rheumatic fever and glomerulonephritis ^[3]^[2].

Epidemiology

Historical records document high morbidity and mortality rates during extensive epidemics throughout Europe and the United States during the eighteenth and nineteenth centuries ^[1]. After nearly disappearing during the twentieth century, the disease has recently resurged in several countries, with Europe experiencing a significant post-pandemic incidence increase ^[2]^[1]. Worldwide burden remains considerable, with Group A Streptococcus infections contributing to over half a million fatalities annually, while circulating lineages increasingly display altered antimicrobial susceptibility patterns ^[3]^[2].

Transmission

Streptococcus pyogenes deploys a range of virulence determinants that facilitate host colonization and subsequent dissemination within the host ^[3]. These mechanisms disrupt both innate and adaptive immune defenses, enabling pathogen persistence and transmission to new susceptible individuals ^[3].

Prevention

The World Health Organization has developed preferred vaccine characteristics to stimulate development of safe and effective vaccines against Streptococcus pyogenes ^[3].

References

1Managing scarlet fever. Drug Ther Bull. 2017 Sep. PMID: 28882851. doi: 10.1136/dtb.2017.8.0529.PubMed: https://pubmed.ncbi.nlm.nih.gov/28882851/
2Matsubara VH et al. Recrudescence of Scarlet Fever and Its Implications for Dental Professionals. Int Dent J. 2023 Jun. PMID: 37062653. doi: 10.1016/j.identj.2023.03.009.PubMed: https://pubmed.ncbi.nlm.nih.gov/37062653/
3Brouwer S et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023 Jul. PMID: 36894668. doi: 10.1038/s41579-023-00865-7.PubMed: https://pubmed.ncbi.nlm.nih.gov/36894668/
4Muzumdar S et al. The rash with maculopapules and fever in children. Clin Dermatol. 2019 Mar-Apr. PMID: 30981292. doi: 10.1016/j.clindermatol.2018.12.005.PubMed: https://pubmed.ncbi.nlm.nih.gov/30981292/

Coding Register

ICD-10: A38
ICD-11: 1C1Z

Key Statistics

Total cases: 946K
Total deaths: 9
Peak month: 2017-05
Coverage: 4 reporting countries · 1997-01-01 → 2026-09-01

Coverage

Reporting countries and regions

4 locations

Trends by reporting country

Monthly patterns over time

Research Radar

Recent related research

View all research →

Peer reviewedOpen accessScarlet feverSurveillance

DOI 10.1186/s12879-026-13770-0 ↗

Epidemiological characteristics and spatiotemporal analysis of scarlet fever in Guangzhou, China: the surveillance of 20 years

Hong-rou Lin, Jiangrong Wang, Jiamin Shan +8 more

BMC Infectious DiseasesJun 26, 2026

Open article ↗Scarlet fever surveillance →

Peer reviewedOpen accessScarlet feverAntimicrobial resistance

DOI 10.1186/s12879-020-05241-x ↗

Molecular epidemiology and antimicrobial resistance of group a streptococcus recovered from patients in Beijing, China

Hongxin Li, Lin Zhou, Yong Zhao +3 more

BMC Infectious DiseasesJul 13, 2020

Open article ↗Scarlet fever surveillance →

Literature links are provided for discovery and do not alter or validate the surveillance series above.

Rows14,880

Updated2026-09-01

Coverage—

Partitions7

Source4 series · 7,191 observations

Official sourcesAuthority, cadence, notes72

MONTHLYweb

Monthly notifiable infectious disease reports published by China CDC.

MONTHLYweb

Official China public health bulletin and query portal.

MONTHLYweb

Biomedical literature discovery feed used as supplementary context.

annualofficial_datacenter_spreadsheet

Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.

monthlyofficial_provincial_report