NEW YORK (Reuters Health) – Scarlet fever is making a comeback in England, where diagnosis rates have reached the highest levels in nearly 50 years.
“The numbers of cases of scarlet fever that have been notified to us are surprisingly high, reaching over 19,000 in 2016,” Dr. Theresa Lamagni from National Infection Service, Public Health England (PHE), London, UK, told Reuters Health by email. “Whilst our surveillance data for 2017 suggests a possible reduction, numbers of cases still remain high.”
Both the incidence and severity of scarlet fever have declined in the past two centuries, and what was once a commonplace cause of suffering has been relegated to history. Or so it was thought.
Dr. Lamagni and colleagues document a sudden rise in the incidence of scarlet fever beginning in 2014 across England, Wales, and Northern Ireland. They reported their findings online November 27 in The Lancet Infectious Diseases.
From a baseline incidence between 3.1 and 8.2 cases of scarlet fever per 100,000 population from 1999 to 2013, representing 1,600 to 4,700 cases per calendar year, scarlet fever notifications more than tripled to 15,637 during 2014 (27.2 cases per 100,000 population).
Scarlet fever notifications increased further in 2015 (17,696 cases; 30.6 per 100,000 population) and 2016 (19,206 cases; 33.2 per 100,000), the highest levels since 1967.
Most cases (87%) in 2014 were in children under age 10, although infected individuals ranged in age from 0 to 90. Both sexes were affected equally in children, whereas adult rates were twice as high in women as in men.
Notifications of laboratory-confirmed invasive group A streptococcal infections followed the same seasonal pattern as scarlet fever – a rise through winter with a peak in early spring – and throat isolates obtained across England from patients with scarlet fever identified a genetically diverse population with 16 different “emm” gene types represented.
Since the early 1900s, there has been a marked cyclical surge in scarlet fever cases and deaths, peaking at a median of every 4 years, with an average magnitude of increase between the lowest and highest points within each cycle of 41%. In contrast, scarlet fever notifications in the current upsurge have increased 6.85-fold since 2011, the year with the lowest incidence point in the current cycle.
Epidemiological analysis revealed no change in seasonal pattern or demographic features of cases during the current upsurge, leaving researchers at a loss to explain the ongoing resurgence.
“Our priority is to make sure that the public and healthcare professionals remain informed of the current elevation in scarlet fever,” Dr. Lamagni said. “This will help to get people seen by their GPs and receive treatment to minimize the risk of complications and onwards transmission of the infection.”
“Scarlet fever is a notifiable condition, so we remind clinicians of the importance of promptly notifying cases to their local PHE Health Protection Teams,” she said. “This helps local teams assess the changing situation in real-time, including identifying and responding to outbreaks. National guidelines are available to provide advice to schools and nurseries on how outbreaks should be managed.”
“We have a number of studies underway to see if there are additional measures which could be put in place to control the spread of infection both in household and childcare settings,” Dr. Lamagni said. “As well as increasing our scientific knowledge on how these infections spread within our communities, this research will directly inform the measures we put in place to limit the spread of scarlet fever.”
Dr. Benjamin J. Cowling from The University of Hong Kong told Reuters Health by email, “I am not surprised that scarlet fever is resurging in the UK, given what has happened in Hong Kong in the past 5 years. I would expect other European countries to see more scarlet fever cases in the next few years.”
“Physicians should be alert to the possibility of scarlet fever in patients with fever, sore throat, a rash, and a bright-red tongue,” he said.
“We still do not understand why scarlet fever is resurging,” Dr. Cowling said. “One other concern, not raised in the article, is the potential for antibiotic-resistant strains to emerge.”
SOURCE: http://bit.ly/Ll5ou3
Lancet Infect Dis 2017.
Tidak ada komentar:
Posting Komentar