Clinical manifestations of scarlet fever in children in the megalopolis at the present stage

BACKGROUND: According to the literature, an increase in severe forms of scarlet fever among children was noted in several countries in 2022–2023.

AIM: To identify the current clinical features of scarlet fever in children in a large metropolis in Russia.

MATERIALS AND METHODS: An observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted based on patient case histories from 2020 to 2022.

Statistical processing was performed using methods for calculating extensive and intensive indicators (p₁ and p₂), errors of extensive indicators (m₁ and m₂), and standard deviations (p_max↔ p_min), considering the confidence interval (t) and confidence probability (P=95%).

The percentages were compared using Fisher’s exact criterion. The differences were considered significant at p <0.05.

RESULTS: The abolition of anti-epidemic restrictions on COVID-19 in 2022 led to an increase in the incidence of scarlet fever among children aged 0–18 years by 3.6 times compared to that in 2021 and to an increase in hospitalization in hospitals in Moscow. The number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to that in 2020. Majority of those hospitalized (83.4%) were children of preschool and school age, including those aged 3–7 years (52.9%) and 7–15 years (39.3%), with an average severity of the disease of 93.6%.

Among the examined children, 53 (18.0%) had a history of COVID-19, and among this group of children, one in 5^th had severe scarlet fever.

Every 8^th–9^th patient (12.2%) had various complications, mainly of a septic nature, that occurred at week 1 of the disease; at week 2 and later, complications of infectious and allergic nature were observed.

Antibiotics of the cephalosporin (53.6%) and penicillin (46.4%) series were used to treat scarlet fever.

CONCLUSION: In modern conditions of the megalopolis, scarlet fever occurs with typical clinical characteristics. In most children, scarlet fever was characterized by a moderate course, and various complications were identified in 12.2% of children. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases and the incidence of complications does not change (12.3–12.8%). Scarlet fever is 8.3 times more likely to occur in severe form in patients who have had COVID-19 than in those who did not have a history of COVID-19.