Strict hygienic measures in schools against scarlet fever

Schools across Malta and Gozo have been asked to follow strict hygienic measures to halt the spread of scarlet fever which made an appearance among children in the last school term.

Charmaine Gauci, the head of the Health Promotion and Disease Prevention Department, said the measures were needed especially because the bacteria that causes scarlet fever can live outside the body for a number of days. This facilitates transmission, making frequent hand washing of the utmost importance.

A scientific working group within the Health Division is working to pinpoint what triggered the outbreak.

Scarlet fever is caused by an infection from a streptococcus bacteria, normally occurring after a throat or skin infection. Although it used to be a very serious disease, most cases today are relatively mild. The characteristic symptom is a fine pinkish-red rash that feels like sandpaper. It may start in one place but soon spreads to many parts of the body.

Children are more predisposed to falling ill with scarlet fever especially since the bacteria is predominantly spread through saliva and youngsters have a tendency to put things into their mouth.

"One of the most important means of control is to remove the source of infection," Dr Gauci said.

She explained that if an infected child puts his hand into his mouth and then touches a toy, there is a good chance that the bacteria has been transferred onto that toy, which could then be picked up by another child.

Apart from stressing the importance of cleaning surfaces with warm soapy water, the department has also made sure that any sick children stay at home to stop them spreading the illness. Scarlet fever came into the public eye towards the end of January when two children attending the same class at a Gozo school contracted the illness. Early last month the department reported another small outbreak in another school in Gozo, followed by a second one in the same school a week later.

In both cases all the children in those classrooms were asked not to go to school for five days to halt the spread of disease. Three classes, in two different schools, were closed in another precautionary measure.

Another outbreak took place just before Easter with five children attending the same class, again in Gozo, falling ill. Schools then went on Easter break but parents of the other children in that classroom were still informed.

Since school reopened this week, the department has not been informed of any other cases, Dr Gauci said.

Sporadic cases of scarlet fever have been seen across the islands but it was only in Gozo that the cases were linked. Dr Gauci said none of the family members of the infected children have fallen ill with scarlet fever.

She pointed out that considering the enhanced surveillance, the authorities were bound to see more cases.

The small outbreaks in schools have worried teachers in Gozo and a number have contacted the Malta Union of Teachers to raise their concerns. MUT president John Bencini lamented that the union was not being given enough clear information by the authorities.

He said teachers were afraid that the bacteria would spread and were expecting the union to issue directives.

The union, however, feels it is not in a position to do so since this is not something that is only affecting teachers. "What will happen to the children if we issue directives for teachers to stay away from school?" he said.

He did add, however, that the union might have to resort to that course of action if it felt that not enough was being done to contain the problem. As a last resort, affected schools should be closed until things settled, as "health comes first".

Dr Gauci said such a measure was not necessary since scarlet fever spread through close, prolonged contact, making the closure of individual classrooms enough. Neither was it enough for the children to mix during breaks for the illness to spread, she said when asked.