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On Tuesday, in UK: Essex NHS Reports Outbreak Of Invasive Group A Streptococcus - 12 deaths, we looked at reports of an unusual cluster of iGAS (Invasive Group A Streptococcus) cases in Essex County, in the South-east of the United Kingdom.
While a definitive cause of this outbreak has yet to be established, the NHS is taking steps to prevent potential transmission via asymptomatic carriers, and is working to improve hand hygiene and the use of PPEs by local nurses.According to the latest statement, the NHS is giving nursing staff who treat patients with chronic wounds antibiotic prophylaxis, has conducted a deep cleaning of community nurse bases, and is restricting Braintree district nurse teams from working outside out their postcode.
The ability of asymptomatic carriers to spread Strep A is only poorly understood, but the CDC states:
Carriage
Asymptomatic group A strep carriers usually do not require treatment. Carriers have positive throat cultures or are RADT positive, but do not have clinical symptoms or an immunologic response to group A strep antigens on laboratory testing.
Compared to people with symptomatic pharyngitis, carriers are much less likely to transmit group A strep to others. Carriers are also very unlikely to develop suppurative or nonsuppurative complications.The full statement from the Mid Essex NHS follows, after which I'll have a bit more:
Mid Essex streptococcus outbreak – statement by Dr Anna Davey, CCG Chair, at Board todayFor a more complete look at the knowns and unknowns of asymptomatic carriage of Strep A, you may wish to review the following article published in 2014.
At the CCG's Board meeting in public held at Spring Lodge Community Centre in Witham this afternoon (Thursday 27 June), our Chair, Dr Anna Davey, gave the following update on the invasive Group A Streptococcus (iGAS) outbreak in mid Essex.
I want to give you all an update on the ongoing incident here in mid Essex. Twelve people have sadly died and I want to start by expressing our sincere condolences to their families.
We have established an incident management team and are working hard with colleagues from Public Health England, Provide Community Interest Company, who provide the majority of our out of hospital services, NHS England and NHS Improvement, to understand why this has happened and to prevent any more cases from occurring.
There have been 32 cases of iGAS in Essex. Those affected are elderly people in Braintree District, Chelmsford City and Maldon District. The vast majority of patients were receiving treatment for wounds, some in care homes but most in their own homes. A single case was found in Basildon in 2018 and a single case in Southend in February 2019. There does not appear to be a direct link between the cases in south Essex and mid Essex.
To give you a brief overview, Group A streptococcus, or GAS bacteria, can be found in the throat and on the skin and will not cause any illness for most people. Most Group A streptococcus infections can cause mild illnesses such as a sore throat, also known as strep throat, scarlet fever or a skin infection. For most healthy people this will cause no more than a mild illness.
On rare occasions, this bacteria can enter the body and cause severe, and sometimes life-threatening conditions. This is called Invasive Group A Streptococcal disease – iGAS. While this infection is rare, it is not new and has been seen in the UK before.
We have put in place measures to prevent the spread of this infection, including giving all community nursing staff who treat patients with chronic wounds antibiotic prophylaxis.
A deep cleaning of all community nurse bases has been conducted on all premises and to ensure the infection does not spread out of the locality, district nurse teams working within the CM7 Braintree area are only working within this postcode for the time being. This is because the majority of cases have been within this area.
We are taking wound swabs from all patients who are being treated for wounds in the area to check for the bacteria, and increasing opportunities for hand hygiene and use of personal protective equipment among staff.
We understand this is a worrying time for people, and know how frustrating it is that we don’t have answers to lots of the questions you may have. But we want to reassure members of the public that the risk of contracting iGAS is very low for most people. Treatment with antibiotics is very effective if started early.
We are continuing to work with Public Health England to stop the spread of this outbreak and ensure our local community is protected.
Our Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection.We will also continue to keep our website updated as and when we have more information on the outbreak or investigation.
The Group A Streptococcal Carrier State Reviewed: Still an Enigma(SNIP)
Gregory P. DeMuri Ellen R. Wald
Journal of the Pediatric Infectious Diseases Society, Volume 3, Issue 4, December 2014, Pages 336–342, https://doi.org/10.1093/jpids/piu030
Abstract
Despite the common nature of group A streptococcal (GAS) infections, the carrier state of this organism is not well understood. In this article, we review the historical and recent research on the definition, epidemiology, and pathogenesis of the GAS carrier state. In addition, we outline trials of antimicrobial agents in the eradication of the carrier state and discuss indications for providing treatment to patients in the clinical setting.
CONCLUSIONS
Despite decades of research, the GAS carrier state remains poorly understood. A working definition used in some clinical trials and practical to clinicians is the patient who harbors GAS in the pharynx after adherence to an appropriate antibiotic for an episode of pharyngitis presumed to be caused by GAS.
Streptococcal carriers are common in school-age populations, representing 10%–15% of children in most surveys. Carriers have little risk for nonsuppurative complications of GAS and though they may possibly transmit the organism to others, the degree of communicability is less than from acutely infected individuals. Most children who are carriers do not require treatment, but an attempt at eradication of the carrier state may be of benefit in select children.
