Definition and research guide
This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.
Content available: 4 complete abstracts (949 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.
Definition
Infection with group A streptococci that is characterized by tonsillitis and pharyngitis. An erythematous rash is commonly present.
Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.
Also known as: Fever, Scarlet; Fevers, Scarlet; Scarlet Fevers.
Where it fits in the MeSH classification
- Broader topics
- Streptococcal Infections
Research landscape
PubMed indexes 2,167 records tagged with the MeSH heading “Scarlet Fever” (counts retrieved 2026-10-29). 104 of them (4.8%) were published from 2020 onward, and the busiest period so far is through 1999 with 1,818 records.
Reviews account for 62 records (2.9%) and meta-analyses for 0. Randomized controlled trials number 5 (0.2%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.
Show the data
| Period | Records |
|---|---|
| through 1999 | 1,818 |
| 2000-2009 | 102 |
| 2010-2019 | 143 |
| 2020 onward | 104 |
Publication-type chart data
| Type | Records | Share |
|---|---|---|
| Reviews | 62 | 2.9% |
| Meta-analyses | 0 | 0.0% |
| Randomized controlled trials | 5 | 0.2% |
Method: PubMed query "Scarlet Fever"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-29.
Reading the evidence in infectious diseases
Infectious disease evidence combines microbiology, epidemiology and clinical trials. Laboratory studies identify pathogens and how they cause harm; surveillance and outbreak investigations describe who is affected and how infection spreads; trials establish whether treatments and vaccines work. Results depend on place and time, because pathogens evolve and resistance patterns and population immunity change. Check when and where the data were collected, how cases were defined and how up to date the evidence is.
Evidence from open-access studies
These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.
Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study [1]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundSince 2014, England has seen increased scarlet fever activity unprecedented in modern times.
- Closing excerpt
- FundingUK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (341 words)
BackgroundSince 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England's scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events.MethodsWe analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014-16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009-16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses.FindingsCoincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (pUK)-with overlap of pharyngitis, scarlet fever, and invasive M1UK strains-which could be genotypically distinguished from pandemic emm1 isolates (M1global) by 27 single-nucleotide polymorphisms. Median SpeA protein concentration in supernatant was nine-times higher among M1UK isolates (190·2 ng/mL [IQR 168·9-200·4]; n=10) than M1global isolates (20·9 ng/mL [0·0-27·3]; n=10; pUK expanded nationally to represent 252 (84%) of all 299 emm1 genomes in 2016. Phylogenetic analysis of published datasets identified single M1UK isolates in Denmark and the USA.InterpretationA dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1UK and recognised invasive potential of emm1 S pyogenes provide plausible explanation for the increased incidence of invasive disease, and rationale for global surveillance.FundingUK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 31519541 · DOI · PMC6838661
Detection of Streptococcus pyogenes M1UK in Australia and characterization of the mutation driving enhanced expression of superantigen SpeA [2]
Abstract reading summary — source excerpts
- Opening excerpt
- A new variant of Streptococcus pyogenes serotype M1 (designated 'M1UK') has been reported in the United Kingdom, linked with seasonal scarlet fever surges, marked increase in invasive infections, and exhibiting enhanced expression of the superantigen SpeA.
- Closing excerpt
- This represents a previously unappreciated mechanism of toxin expression and urges enhanced international surveillance.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (152 words)
A new variant of Streptococcus pyogenes serotype M1 (designated 'M1UK') has been reported in the United Kingdom, linked with seasonal scarlet fever surges, marked increase in invasive infections, and exhibiting enhanced expression of the superantigen SpeA. The progenitor S. pyogenes 'M1global' and M1UK clones can be differentiated by 27 SNPs and 4 indels, yet the mechanism for speA upregulation is unknown. Here we investigate the previously unappreciated expansion of M1UK in Australia, now isolated from the majority of serious infections caused by serotype M1 S. pyogenes. M1UK sub-lineages circulating in Australia also contain a novel toxin repertoire associated with epidemic scarlet fever causing S. pyogenes in Asia. A single SNP in the 5' transcriptional leader sequence of the transfer-messenger RNA gene ssrA drives enhanced SpeA superantigen expression as a result of ssrA terminator read-through in the M1UK lineage. This represents a previously unappreciated mechanism of toxin expression and urges enhanced international surveillance.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 36828918 · DOI · PMC9951164
Scarlet Fever Epidemic in China Caused by Streptococcus pyogenes Serotype M12: Epidemiologic and Molecular Analysis [3]
Abstract reading summary — source excerpts
- Opening excerpt
- From 2011, Hong Kong and mainland China have witnessed a sharp increase in reported cases, with subsequent reports of epidemic scarlet fever in North Asia and the United Kingdom.
- Closing excerpt
- These findings emphasize the role of comprehensive surveillance approaches for monitoring of epidemic human disease.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (264 words)
From 2011, Hong Kong and mainland China have witnessed a sharp increase in reported cases, with subsequent reports of epidemic scarlet fever in North Asia and the United Kingdom. Here we examine epidemiological data and investigate the genomic context of the predominantly serotype M12 Streptococcus pyogenes scarlet fever isolates from mainland China. Incident case data was obtained from the Chinese Nationwide Notifiable Infectious Diseases Reporting Information System. The relative risk of scarlet fever in recent outbreak years 2011-2016 was calculated using the median age-standardised incidence rate, compared to years 2003-2010 prior this outbreak. Whole genome sequencing was performed on 32 emm12 scarlet fever isolates and 13 emm12 non-scarlet fever isolates collected from different geographic regions of China, and compared with 203 published emm12 S. pyogenes genomes predominantly from scarlet fever outbreaks in Hong Kong (n=134) and the United Kingdom (n=63). We found during the outbreak period (2011-2016), the median age-standardised incidence in China was 4.14/100,000 (95% confidence interval (CI) 4.11-4.18), 2.62-fold higher (95% CI 2.57-2.66) than that of 1.58/100,000 (95% CI 1.56-1.61) during the baseline period prior to the outbreak (2003-2010). Highest incidence was reported for children 5years of age (80.5/100,000). Streptococcal toxin encoding prophage φHKU.vir and φHKU.ssa in addition to the macrolide and tetracycline resistant ICE-emm12 and ICE-HKU397 elements were found amongst mainland China multi-clonal emm12 isolates suggesting a role in selection and expansion of scarlet fever lineages in China. Global dissemination of toxin encoded prophage has played a role in the expansion of scarlet fever emm12 clones. These findings emphasize the role of comprehensive surveillance approaches for monitoring of epidemic human disease.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 29342444 · DOI · PMC5835554
Epidemiological characteristics and spatiotemporal analysis of scarlet fever in Guangzhou, China: the surveillance of 20 years [4]
Abstract reading summary — source excerpts
- Opening excerpt
- BackgroundThis study investigated the epidemiological and spatiotemporal characteristics of scarlet fever in Guangzhou, China, and provided a scientific basis for the formulation and optimization of prevention and control strategies.
- Closing excerpt
- Control strategies should target high-risk seasons, populations and regions to reduce scarlet fever cases.
- Interpretation limits
- Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (192 words)
BackgroundThis study investigated the epidemiological and spatiotemporal characteristics of scarlet fever in Guangzhou, China, and provided a scientific basis for the formulation and optimization of prevention and control strategies.MethodsThe epidemiological profile of scarlet fever was systematically reviewed using descriptive analysis. We used the Moran's I, local indicators of spatial association, and the retrospective spatiotemporal scanning statistical analysis to study the spatiotemporal aggregation phenomenon of scarlet fever in Guangzhou.ResultsFrom 2005 to 2024, 9,601 scarlet fever cases were reported within Guangzhou, with an annual average morbidity of 3.16 per 100,000. Joinpoint regression analysis indicated a statistically significant overall upward trend in scarlet fever incidence (AAPC = 17.26%, p ConclusionsThis study reveals a significant spatial-temporal clustering of scarlet fever in Guangzhou from 2005 to 2024, characterized by an overall upward trend and a notable recent resurgence. The high-risk regions were predominantly localized within the central urban regions and expanding peri-urban growth centers, such as Helong, Licheng, Meihuacun, and their surrounding regions. The outbreak mostly affects kindergarten children aged 3-6 years and students aged 7-10 years, with winter and spring as peaks. Control strategies should target high-risk seasons, populations and regions to reduce scarlet fever cases.
Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42363098 · DOI · PMC13563735
Key reviews and meta-analyses
The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.
- Research article Comprehensive review of morbidity and mortality trends for rheumatic fever, streptococcal disease, and scarlet fever: the decline of rheumatic fever [5]
- Research article MRSA, staphylococcal scalded skin syndrome, and other cutaneous bacterial emergencies [6]
- Research article Streptococcal superantigens and the return of scarlet fever [7]
- Research article Managing scarlet fever [8]
- Research article Recrudescence of Scarlet Fever and Its Implications for Dental Professionals [9]
- Research article Prevalence and persistence of certain serologic types of Streptococcus pyogenes in metropolitan Tokyo [10]
References
- Lynskey NN, Jauneikaite E, Li HK, Zhi X, Turner CE, Mosavie M, et al.. Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study. . 2019. PMID 31519541 · DOI · PMC6838661
- Davies MR, Keller N, Brouwer S, Jespersen MG, Cork AJ, Hayes AJ, et al.. Detection of Streptococcus pyogenes M1UK in Australia and characterization of the mutation driving enhanced expression of superantigen SpeA. . 2023. PMID 36828918 · DOI · PMC9951164
- You Y, Davies MR, Protani M, McIntyre L, Walker MJ, Zhang J. Scarlet Fever Epidemic in China Caused by Streptococcus pyogenes Serotype M12: Epidemiologic and Molecular Analysis. . 2018. PMID 29342444 · DOI · PMC5835554
- Lin HR, Wang J, Shan J, He Q, Dong S, Deng Q, et al.. Epidemiological characteristics and spatiotemporal analysis of scarlet fever in Guangzhou, China: the surveillance of 20 years. . 2026. PMID 42363098 · DOI · PMC13563735
- Quinn RW. Comprehensive review of morbidity and mortality trends for rheumatic fever, streptococcal disease, and scarlet fever: the decline of rheumatic fever. Rev Infect Dis. 1989. PMID 2690288 · DOI
- Berk DR, Bayliss SJ. MRSA, staphylococcal scalded skin syndrome, and other cutaneous bacterial emergencies. Pediatr Ann. 2010. PMID 20954609 · DOI
- Hurst JR, Brouwer S, Walker MJ, McCormick JK. Streptococcal superantigens and the return of scarlet fever. PLoS Pathog. 2021. PMID 34969060 · DOI · PMC8717983
- . Managing scarlet fever. Drug Ther Bull. 2017. PMID 28882851 · DOI
- Matsubara VH, Christoforou J, Samaranayake L. Recrudescence of Scarlet Fever and Its Implications for Dental Professionals. Int Dent J. 2023. PMID 37062653 · DOI · PMC10213718
- Iimura T, Kashiwagi Y, Endo M, Amano Y. Prevalence and persistence of certain serologic types of Streptococcus pyogenes in metropolitan Tokyo. J Infect Chemother. 2006. PMID 16648943 · DOI
About this article
- Sources
- NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
- Verification
- Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
- Review state
- automated source verified; no human expert review has been recorded yet.
- Version
- 1, last updated 2026-10-29.
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Evidence strength
EvidenceHelix's computed view of the study designs behind this topic: how common meta-analyses, randomized trials and reviews are, how recent the literature is, and a plain-language reading. It describes the design mix of the literature. It is not a quality appraisal of any study, and it is not medical advice.