Objective To analyze the epidemiological characteristics and incidence trend of scarlet fever in Zhangjiagang City from 2005 to 2018, so as to provide basis for prevention of scarlet fever outbreak. Methods Data of scarlet fever cases reported by Zhangjiagang Infectious Disease Reporting Information Management System from 2005 to 2018 were analyzed retrospectively, control chart of epidemic was used to predict the incidence trend of scarlet fever from February to June 2019. Results From 2005 to 2018, 584 cases of scarlet fever were reported in Zhangjiagang City, with an average annual incidence of 2.64/100 000, and there was no death case. From 2005 to 2010, the reported incidence was in a slow and steady stage, with an average annual incidence of 1.04/100 000; from 2011 to 2018, incidence of reported cases was in a rising stage, annual incidence was 3.85/100 000, the reported cases increased obviously. The ratio of incidence of male to female was 1.58:1, 3-12-year-old group had the highest incidence, accounting for 95.21% (556/584). The main reporting units of scarlet fever were tertiary medical institutions, accounting for 85.96% (502/584). Seasonal distribution of scarlet fever was obvious, incidence of scarlet fever was high in April-June each year and November to January of next year, it is predicted that incidence of scarlet fever would be maintained at a high level in February-June of 2019. Conclusion Incidence of scarlet fever in Zhangjiagang City is in an increased trend from 2011 to 2018, 3-12-year-old is the main group. According to the incidence trend from 2011 to 2018, it is predicted that February to June 2019 will be the peak stage of scarlet fever in Zhangjiagang City, prevention and control measures of scarlet fever in kindergartens, schools and crowded places should be strengthened, diagnostic sensitivity of medical institutions needs to be improved, so as to prevent the outbreak of scarlet fever.