ArticleThe Lancet. Infectious diseases2018
Resurgence of scarlet fever in England, 2014-16: a population-based surveillance study.
Article in The Lancet. Infectious diseases, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
74 citing papers in PubMed, 1 synthesis or guideline pooled it, 162 citations in OpenAlex.
- Burden of infectious disease studies in Europe and the United Kingdom: a review of methodological design choices.Epidemiology and infection · 2023Pooled it
- Tracing the recent evolution of Group AEmerging microbes & infections · 2026Review
- Epidemiological characteristics and spatiotemporal analysis of scarlet fever in Guangzhou, China: the surveillance of 20 years.BMC infectious diseases · 2026Article
- The role of school terms in the epidemics of scarlet fever among pre-school-aged and school-aged children: a 15-year population-based surveillance in China.BMC public health · 2026Article
- Emergence of distinct Streptococcus pyogenes emm1 and emm12 lineages in China.Nature microbiology · 2026Article
- Before and after the bottleneck: pediatric group A streptococcal infections in Houston, TX, from 2013 to 2023.Microbiology spectrum · 2026Article
- Editorial: New discoveries and challenges in pediatric infectious diseases: epidemiological, clinical, and pathogenic advances.Frontiers in pediatrics · 2026Article
- Case Report: FatalFrontiers in medicine · 2026Article
- Scarlet fever and meteorological exposures in Jiangsu, China: a time-stratified case-crossover study.BMC public health · 2025Article
- Scarlet Fever in Iran During the Qajar Period (1796 to 1925 AD); A Brief Historical Review.Archives of Iranian medicine · 2025Article
- Immunity to Streptococcus pyogenes and Common Respiratory Viruses at Age 0 to 4 Years After COVID-19 Restrictions.JAMA network open · 2025Article
- Multi-country surveillance of paediatric invasive group AEuro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2025Article
- Engaging Broader Stakeholders to Accelerate Group AVaccines · 2025Review
- Post-pandemic upsurge in Group AMicrobiology spectrum · 2025Article
- Invasive Group A Streptococcal Infection in Children, 1992-2023.JAMA network open · 2025Article
- Localized Leg Erythema as the Primary Symptom of Scarlet Fever: An Atypical Presentation.Cureus · 2025Article
- Characterization of a novelmBio · 2025Article
- Global spread of Streptococcus pyogenes A genomics-supported narrative review.FEMS microbiology reviews · 2025Review
- Article
- The intricate pathogenicity of Group AVirulence · 2024Review
14 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
Authors and funding
13 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundAfter decades of decreasing scarlet fever incidence, a dramatic increase was seen in England beginning in 2014. Investigations were launched to assess clinical and epidemiological patterns and identify potential causes.
methodsIn this population-based surveillance study, we analysed statutory scarlet fever notifications held by Public Health England from 1911 to 2016 in England and Wales to identify periods of sudden escalation of scarlet fever. Characteristics of cases and outbreaks in England including frequency of complications and hospital admissions were assessed and compared with the pre-upsurge period. Isolates from throat swabs were obtained and were emm typed.
findingsData were retrieved for our analysis between Jan 1, 1911, and Dec 31, 2016. Population rates of scarlet fever increased by a factor of three between 2013 and 2014 from 8·2 to 27·2 per 100 000 (rate ratio [RR] 3·34, 95% CI 3·23-3·45; p<0·0001); further increases were observed in 2015 (30·6 per 100 000) and in 2016 (33·2 per 100 000), which reached the highest number of cases (19 206) and rate of scarlet fever notifcation since 1967. The median age of cases in 2014 was 4 years (IQR 3-7) with an incidence of 186 per 100 000 children under age 10 years. All parts of England saw an increase in incidence, with 620 outbreaks reported in 2016. Hospital admissions for scarlet fever increased by 97% between 2013 and 2016; one in 40 cases were admitted for management of the condition or potential complications. Analysis of strains (n=303) identified a diversity of emm types with emm3 (43%), emm12 (15%), emm1 (11%), and emm4 (9%) being the most common. Longitudinal analysis identified 4-yearly periodicity in population incidence of scarlet fever but of consistently lower magnitude than the current escalation.
interpretationEngland is experiencing an unprecedented rise in scarlet fever with the highest incidence for nearly 50 years. Reasons for this escalation are unclear and identifying these remains a public health priority.
fundingNone.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.