Primary prevention
Good hand hygiene and respiratory etiquette can reduce the spread of all types of group A streptococcal infections, including scarlet fever.[10] There is increasing evidence that the bacteria are spread via respiratory particles.[20]
Good hand hygiene includes washing hands with soap and water for at least 20 seconds or using alcohol-based hand gel consistently, particularly after coughing and sneezing and before preparing foods or eating.
Respiratory etiquette includes covering coughs and sneezes, and washing handkerchiefs or disposing of contaminated tissues.
There is evidence that most patients who are being treated with an antibiotic for 24 hours or longer are generally no longer infectious after this time.[21] However, the Centers for Disease Control and Prevention recommends that patients with scarlet fever should stay home from work, school, or daycare until they are afebrile AND at least 12 hours have passed after initiation of appropriate antibiotic therapy.[10]
The incubation period of scarlet fever is approximately 2-5 days.[10]
Secondary prevention
Antibiotic prophylaxis against group A streptococcal infection is recommended only in patients with a previous diagnosis of acute rheumatic fever. This is to prevent progression to rheumatic heart disease with subsequent re-infection. The Centers for Disease Control and Prevention (CDC) and the American Heart Association recommend long-term prophylaxis with an intramuscular injection of benzathine penicillin G every 3-4 weeks or oral penicillin V twice daily.[42][66][67] The CDC recommends daily sulfadiazine or oral macrolides for those allergic to penicillin.[66]
Scarlet fever is not a notifiable disease in the US.
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