Officials in Hong Kong are urging the public to be vigilant and take precautions against scarlet fever as they reported a second suspected death from the disease involving a 5-year-old boy on Tuesday, and the latest figures show 466 cases have so far been reported to the Centre for Health Protection (CHP) of the Department of Health this year.

The boy started showing symptoms of fever on 15 June and was admitted to Princess Margaret Hospital on June 19 when his condition deteriorated suddenly. Unfortunately he developed toxic shock syndrome and died on 21 June, said the CHP in Tuesday’s daily update.

Last month, the disease claimed the life of a 7-year-old girl.

Scarlet fever is a very contagious bacterial illness which presents as a fever, sore throat, and a distinctive pink-red rash. It is caused by a Group A Streptococcus bacteria and can be cured with antibiotics.

The disease usually affects children under ten years of age, and is trasmitted by airborne droplets produced when an infected person sneezes or coughs. Incubation ranges from 1 to 3 days.

Initial lab tests have confirmed the 5-year-old boy had gram-positive cocci in his blood; further tests are now being done to confirm it was scarlet fever.

The boy had earlier seen a GP for chickenpox, and there is a chickenpox outbreak at the SA Tin Ka Ping Kindergarten he attended in the district of Sha Tin. But although no other scarlet fever cases have been reported from there, under CHP advice it is expected the kindergarten will close for a week as a precautionary measure.

A CHP spokesman said they had visited the kindergaren and “advised its staff to conduct thorough cleansing and disinfection in the campus”.

He said a public education campaign will be starting next week, advising people on how to prevent scarlet fever infection. He urged anyone who thinks they may have the disease to see their doctor straight away.

“Members of the public should maintain vigilance against scarlet fever as the number of reported cases remained at a high level,” he warned.

The CHP advises members of the public to “maintain good personal and environmental hygiene”, by which they mean keeping the mouth and nose covered when coughing and sneezing; frequently washing hands with soap and water, especially after touching handkerchiefs or tissues when wiping away “respiratory secretions”; appropriately disposing of tissues and handkerchiefs and nasal and mouth discharge; and keeping rooms well aired.

In the latest daily update, the CHP reported 466 cases of scarlet fever, including 26 cases (16 boys, 10 girls, aged from 3 to 12) reported in the 24 hours leading up to noon on 21 June.

Cases of scarlet fever have also been reported in mainland China and Macau.

Scientists in Hong Kong suspect the disease is spreading more quickly than usual because of a mutation in the bacteria.

According to a BBC report, Dr Thomas Tsang, controller of the CHP in Hong Kong, said if it is the case that a genetic mutation is the reason the bacteria is spreading so quickly, then the outbreak may go on for some time.

Sources: CHP Hong Kong, BBC News.

Written by: Catharine Paddock, PhD