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

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^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

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.

Original language	English
Pages (from-to)	915-923
Number of pages	9
Journal	Emerging Infectious Diseases
Volume	28
Issue number	5
DOIs	https://doi.org/10.3201/eid2805.211497
Publication status	Published - May 2022

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© 2022 Centers for Disease Control and Prevention (CDC). All rights reserved.

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title = "Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019",

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.",

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AU - Nabarro, Laura E.

AU - Brown, Colin S.

AU - Balasegaram, Sooria

AU - Decraene, Valérie

AU - Elston, James

AU - Kapadia, Smita

AU - Harrington, Pauline

AU - Hoffman, Peter

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AU - Patel, Bharat

AU - Ready, Derren

AU - Robinson, Esther

AU - Lamagni, Theresa

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N2 - 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.

AB - 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.

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

Abstract

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