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Although Streptococcus pyogenes was a common cause of disease and death in previous centuries, the incidence of scarlet fever, the toxin-mediated disease caused by Streptococcus pyogenes, declined even before antibiotics became available. In 2014, cases and hospitalizations suddenly increased in the U.K., prompting this population surveillance study of scarlet fever notifications to Public Health England from 1911 through 2016 for England and Wales.
Median age of cases was 4 years in 2014. Although 87% of the cases were in children <10 years, age range was 0 to 90 years. In 2016, 620 outbreaks were recorded, primarily in schools and nurseries, and incidence reached 33 per 100,000 population. With the recent increase in cases no changes were …