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Review
. 2022 May;28(5):915-923.
doi: 10.3201/eid2805.211497.

Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018-2019

Laura E Nabarro, Colin S Brown, Sooria Balasegaram, Valérie Decraene, James Elston, Smita Kapadia, Pauline Harrington, Peter Hoffman, Rachel Mearkle, Bharat Patel, Derren Ready, Esther Robinson, Theresa Lamagni
Review

Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018-2019

Laura E Nabarro et al. Emerg Infect Dis. 2022 May.

Abstract

Healthcare-associated invasive group A Streptococcus (iGAS) outbreaks are common worldwide, but only England has reported outbreaks associated with home healthcare (HHC). We describe 10 outbreaks during 2018-2019 in England. A total of 96 iGAS cases (range 2-39 per outbreak) and 28 deaths (case-fatality rate 29%) occurred. Outbreak duration ranged from 3-517 days; median time between sequential cases was 20.5 days (range 1-225 days). Outbreak identification was difficult, but emm typing and whole-genome sequencing improved detection. Network analyses indicated multiple potential transmission routes. Screening of 366 HHC workers from 9 outbreaks identified group A Streptococcus carriage in just 1 worker. Outbreak control required multiple interventions, including improved infection control, equipment decontamination, and antimicrobial prophylaxis for staff. Transmission routes and effective interventions are not yet clear, and iGAS outbreaks likely are underrecognized. To improve patient safety and reduce deaths, public health agencies should be aware of HHC-associated iGAS.

Keywords: Bacteria; England; Group A Streptococcus; Streptococci; Streptococcus pyogenes; disease outbreaks; infection control; long-term care; public health; whole-genome sequencing; wound infection.

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Figures

Figure 1
Figure 1
Annual number of home healthcare–associated invasive group A Streptococcus (iGAS) infection outbreaks reported to Public Health England, January 1, 2013–August 31, 2019. A total of 17 outbreaks occurred during this timeframe, but outbreaks sharply increased during 2018–2019.
Figure 2
Figure 2
Timeline of cases in 9 home healthcare–associated invasive group A Streptococcus (iGAS) infection outbreaks, England, January 1, 2018–August 31, 2019. Vertical black line indicates date that outbreak was declared. Diamonds indicate day of initial detection of iGAS cases: blue diamonds represent patients that survived, red diamonds patients that died. Data from outbreak 10 (39 cases, 15 deaths) were not available.
Figure 3
Figure 3
Intervals between sequential invasive group A Streptococcus (iGAS) cases in 9 home healthcare–associated outbreaks, England, January 1, 2018–August 31, 2019. Data from outbreak 10 were not available.
See this image and copyright information in PMC

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