Group A strep (GAS) and scarlet fever

What is Group A strep?

There are lots of viruses circulating, that cause sore throats, colds and coughs. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell.

Group A streptococci - commonly known as Group A strep - is a common bacterial germ that can cause scarlet fever. These bacteria can also cause other respiratory and skin infections such as strep throat and impetigo (a skin infection).

These are usually mild illnesses, although they're highly infectious they can usually be treated at home with antibiotics.


Look out for symptoms of scarlet fever in your child, which include:

  • Sore throat.
  • Headache.
  • Strawberry tongue or tonsils - this means that it's swollen or bumpy or covered in white spots.
  • A fine, pinkish or red body rash with rougher skin that feels like sandpaper. On darker skin, the rash might be more difficult to see, but the 'sandpaper; feel should be present.
  • A temperature of 38C if they're under 3 months old, or 39C if they're more than 3 months old.
  • If you don't have a thermometer to check their temperature, check if your child feels hotter than usual when you touch their back or chest or feels sweaty.

How is it spread?

Group A strep is spread by close contact with an infected person and can be passed on through coughs, sneezes or from a wound. 

You can help stop the spread of infection through frequent hand washing and by not sharing eating utensils, clothes, bedding and towels. All contaminated tissues should be disposed of immediately.

During periods of high incidence of scarlet fever, there may also be an increase in outbreaks in schools, nurseries and other childcare settings. To reduce the risk of picking up or spreading infections, it's important to:

  • Teach your child to wash their hands properly with soap and warm water for 20 seconds.
  • Teach your child to catch coughs and sneezes into a tissue.
  • Keep your child away from others when they're feeling unwell.

What to do if you think you or your child has scarlet fever

If you think you, or your child, might have scarlet fever:

  • Contact your GP or NHS 111 as soon as possible.
  • Make sure that you or your child take(s) the full course of any antibiotics prescribed. Although you or your child will feel better soon after starting the course of antibiotics, you must complete the course to ensure that you do not carry the bacteria in your throat after you have recovered.
  • Stay at home, away from nursery, school or work for at least 24 hours after starting the antibiotic treatment, to avoid spreading the infection.

Invasive Group A Strep (iGAS)

In very rare occasions, the bacteria can get into parts of the body where it is not normally found, such as the lungs or bloodstream and cause an illness called Invasive Group A strep (iGAS).

While invasive Group A strep is still uncommon, there has been an increase in cases, particularly in children under 10 years old. It is very rare for children with scarlet fever to develop iGAS infection.

As a parent, you should trust your own judgement.

Contact NHS 111 or your GP if:

  • Your child is getting worse.
  • Your child is feeding or eating much less than normal.
  • Your child has had a dry nappy for 12 hours or more or shows other signs of dehydration.
  • Your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher.
  • Your baby feels hotter than usual when you touch their back or chest, or feels sweaty.
  • Your child is very tired or irritable.

Call 999 or go to Accident and Emergency (A&E) if:

  • Your child is having difficulty breathing. You may notice grunting noises or their tummy sucking under their ribs.
  • There are pauses when your child breathes.
  • Your child’s skin, tongue or lips are blue.
  • Your child is floppy and will not wake up or stay awake.
  • Your child has severe pains in their arms, legs, neck or back.
  • Your child has a painful, red area of skin - especially if it's quickly getting bigger.

Further information