If I were writing this response in 1850, my answer would be very different. Until the 20th Century, scarlet fever was one of the most common and deadly childhood diseases. It was dreaded like the plague.
But don’t just take my word for it: the impact of the infection is written all over the pages of literary history. Move over Love in the time of Cholera, scarlet fever shaped the plot of Mary Shelley’s Frankenstein, The Barber of Seville, Little Women, the Sound of Music, and even the Velveteen Rabbit.
Scarlet fever is an infection caused by Streptococcus pyogenes, the same bacteria that s most commonly associated with ’strep throat’ (a nasty type of tonsillitis or sore throat). Humans are the only natural host for the bug and it lives comfortably in our noses and throats. When they get out of hand they sometimes result in infection.
Anyone can catch scarlet fever, but it historically affects children of all ages. Those who are infected haven’t yet developed scarlet fever immunity (from protective antibodies) to ward off infection. The infected is noted for its characteristic red, sunburn-like rash and the appearance of the not-so-tasty ‘strawberry tongue’ (a pale tongue, coated with red spots). The infection is treated with antibiotics and people usually recover within 1-2 weeks.
Severe infections from scarlet fever, along with other major infectious disease such as tuberculosis and cholera, started to decline rapidly during the late nineteenth–early twentieth century. This was thanks to the changes in sanitation and improved living and working conditions. Combined with the widespread use of antibiotics, starting in the 1950s, this hygienic arsenal has all but eliminated the most severe forms of the disease.
Death from scarlet fever is now extremely rare. The US Census Bureau reported only 5 deaths from scarlet fever in 1999, and for much of the 21st Century, no deaths were recorded. So scarlet fever, at least in the dramatic literary sense, is thankfully part of the past. Lucky us!
But mild infections might still be more common than you may think: since 1999, around 10,000 mild cases of scarlet fever were reported in the US (according to the US Census Bureau). This number, however, is likely to be an underestimate, as the official reporting of scarlet fever infections has not been required in the US since 1970. In England, where reporting is required, between 2,000 and 4,000 mild cases of scarlet fever are diagnosed and treated each year – a rate that is probably accurate within Western countries based on their population.
Scarlet Fever is not ‘dead’, but is certainly ‘very sick’ compared to its 19th Century status. Hopefully, it will be consigned to the pages of history in the near future.
Answer by Dr Lanay Tierney
Question from Jessica Le Marquand via Facebook
Annual Summary of Vital Statistics:
Guyer, et al. (2000) Trends in the Health of Americans during the 20th Century. Pediatrics 106:6 1307-1317.
General Background on Step A bacterial infections:
Ralph AP, Carapetis JR. Curr (2013) Group a streptococcal diseases and their global burden. Top Microbiol Immunol. 368:1-27.