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Though you may still associate scarlet fever with the Victorian era (it was what killed Beth in Little Women, after all) it’s been on the rise since 2014. And new research shows that the number of cases in England have a hit the highest level in 50 years.

The BBC reports that an investigation conducted by public health authorities in England and Wales found that scarlet fever cases tripled between 2013 and 2014 and were at their highest in 2016, with 19,206 reported cases mostly occurring in England. That’s the highest number of cases since 1967.

You can look out for scarlet fever symptoms like a sore throat, headache, fever, and a rough red rash. Experts tell the BBC that the rise is “baffling” and no real cause of the increase in cases has been identified. Dr Theresa Lamagni, head of streptococcal surveillance at Public Health England, told the outlet: “We are concerned - it’s quite a dramatic rise.”