Between January and October 2023, scarlet fever outbreaks increased around nine times in the state of São Paulo compared to the same period last year. There are no deaths.
There were 28 outbreaks in the state — one in February, one in June, one in July, nine in August, six in September and ten in October. In the same interval, in 2022, there were three.
According to the State Department of Health, the only scarlet fever outbreak of 2021 occurred in May. In 2020, none were reported and 2019 had 11 outbreaks of the disease, with prevalence in September and October.
In Brazil, only outbreaks are mandatory notification, which means that it is not possible to estimate the number of cases. It is an infectious disease that mostly affects children and adolescents, especially in spring.
Transmission occurs through group A beta-hemolytic streptococcus bacteria (Streptococcus pyogenes), the same cause of tonsillitis, pharyngitis and skin infections, for example. Infection occurs through hands that have touched contaminated areas and been brought to the nose and mouth; through droplets expelled when coughing or sneezing, or through nasal secretion, and by sharing objects.
The bacteria is suspected of having caused the deaths of three children in São João del-Rei (MG) between September and October this year. Fever and sore throat were some of the symptoms.
Scarlet fever usually progresses benignly, but can be serious. The bacteria compromises the child’s general condition and leaves them feeling depressed. Other symptoms include body redness, malaise, lack of appetite and peeling skin. Reddish lumps appear on the tongue and the area around the mouth may turn white.
“The greater the impairment of the general condition, the more important the infectious process is. In people with comorbidities or immunodeficiencies, the tendency is for a much more serious and widespread condition. Scarlet fever by itself, as it has the potential for severity, whenever it happens, needs be evaluated by the doctor so that treatment can be instituted as early as possible”, advises pediatric infectious disease specialist Marcelo Otsuka, vice-president of the scientific department of the São Paulo Society of Pediatrics and coordinator of the pediatric infectious diseases committee of the SBI (Brazilian Society of Infectious Diseases). ).
There is no vaccine against the disease and treatment is based on antibiotics.
From January to October this year, the city of São Paulo confirmed 14 outbreaks with 80 cases in total — in July, one outbreak and two cases; in August, three outbreaks and 23 cases; in September, six outbreaks and 34 cases; in October, four outbreaks and 21 cases.
In the same period of 2022, three outbreaks were recorded with eight cases. In 2020 and 2021 there were no occurrences of the disease.
In Belo Horizonte (MG), care for patients with scarlet fever from January to November 16, 2023 (872) exceeded those provided in the entire year 2022 (325), according to the city hall.
“What I have observed is something very different from what I have ever seen in my life. Me and my pediatrician and infectious disease colleagues. It is not exclusive to Brazil. It is worldwide. In England, in December 2022, the number of cases was much higher than was expected, according to a technical note. Not only from scarlet fever, but from invasive diseases due to Streptococcus pyogenes“, says Marcio Nehab, pediatrician and pediatric infectious disease specialist at the Fernandes Figueira Institute (Fiocruz), and member of SBI.
According to Nehab, the reason is unknown, but there are hypotheses. In one of them, the increase in the disease would be caused by a response to the drop in immunity after the period of social isolation and use of masks due to Covid.
Marcelo Otsuka states that, in the short term, the scenario will return to what was observed in 2019. The expert draws attention to the importance of changing social behavior.
“Viruses will continue to live with us. We are the main spreaders of diseases. So, in addition to the pandemic, we need to understand that, from the moment I have a sick child, with a respiratory condition, it is logical that he should not go to the school. An unimportant infection for one child can be very serious for another”, points out Otuka. “We need to be careful with others and think about them in a more meaningful way.”