Scarlet fever resurgence and declining mortality in China: rethinking diagnosis and surveillance

Shi et al. recently argued that traditional scarlet fever typing in China should be reassessed to improve invasive GAS surveillance, noting that toxic, septic, and surgical forms overlap conceptually with some invasive group A streptococcal disease (iGAS) manifestations but are now rarely used in routine clinical practice.1 This observation helps explain a broader pattern in China: scarlet fever notifications have remained high, with recurrent epidemic peaks, whereas reported mortality has declined markedly compared with the early 1990s.