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Eight days ago, in UK: Essex NHS Reports Outbreak Of Invasive Group A Streptococcus - 12 deaths and again last Friday, 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.
The case count stood at 32 on Friday, but today we learn that a new case has been diagnosed, while a retrospective analysis has turned up another (fatal) case from earlier in the year.While a definitive source of this outbreak has yet to be established, the NHS is taking steps to prevent potential transmission via asymptomatic carriers, and has placed community nurses in the region on prophylactic antibiotics and is working to improve hand hygiene and the use of PPEs by local nurses.
Group A Streptococcus (iGAS) outbreak in mid Essex
Latest update - 3 July 2019
As part of the ongoing iGAS outbreak in mid Essex, NHS Mid Essex Clinical Commissioning Group can confirm that a further patient has been diagnosed with iGAS and is currently being treated.
In addition, as part of the monitoring and risk assessments of this outbreak, Public Health England (PHE) have further reviewed how cases are defined in this outbreak to ensure that all appropriate cases are captured and investigated.
As a result, an additional case has been added to the total outbreak count. This patient passed away with sepsis earlier this year. The case was previously not included in the iGAS count. Therefore, the total number of patients affected by the iGAS outbreak is 34 and 13 of those patients have sadly died.
Background:
Those affected within the iGAS outbreak are older people in Braintree District, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.
Of the 34 confirmed cases, one case was identified in Basildon in 2018 and one case in Southend in February 2019. There does not appear to be a direct link between the cases in south Essex and mid Essex.
NHS Mid Essex Clinical Commissioning Group is leading an incident management team and is working hard with colleagues to manage the situation. These colleagues include Public Health England, Provide Community Interest Company, who provide the majority of mid Essex community health services, NHS England and NHS Improvement.
The control measures put in place to limit the spread of this infection include:
- A programme of preventative antibiotics for the community nursing staff in mid Essex
- Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.
- A deep clean of all community nurse bases in mid Essex and reinforcing standard infection control measures including hand hygiene and use of personal protective equipment among NHS wants to staff continue.
- Swabs are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.
NHS Mid Essex Clinical Commissioning Group wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.
The local NHS Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection.Some people carry the Streptococcus pyogenes bacteria asymptomatically, and while their ability to spread the disease is presumed to be limited, it is not zero (see The Group A Streptococcal Carrier State Reviewed: Still an Enigma by Gregory P. DeMuri & Ellen R. Wald).
Although the risk is low to the general public, those with compromised immune systems, or being treated for open wounds, are particularly vulnerable.The NHS FAQ on Group A Streptococcus includes:
Frequently asked questions:
What is Group A Streptococcus (GAS)?
GAS is a bacterium, full name Streptococcus pyogenes, it is sometimes found in the throat or on the skin and usually causes no symptoms.
How are GAS infections spread?
GAS is spread by contact or by droplets from the respiratory tract, when sneezing or coughing. People may carry GAS in their throat or on their skin, which would make them a carrier, also referred to as colonised. Carriers often have no symptoms of illness.
What infections are caused by GAS?
Most GAS infections result in illnesses such as a sore throat (this can be called ’strep throat’) or a skin infection such as impetigo or scarlet fever. On rare occasions, these bacteria can cause other more severe diseases, for example blood stream infections (septicaemia).
What is invasive group A streptococcal (iGAS)?
iGAS is rare but serious. It can occur when bacteria gets into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are called invasive GAS. In the current outbreak patients with iGAS have suffered septicaemia (blood stream) infection.
What are the signs and symptoms of invasive Group A Streptococcal?
What should I do if I think I have any of the symptoms of iGAS?
- High fever
- Severe muscle aches
- Pain in one area of the body
- Redness at the site of a wound
- Vomiting or diarrhoea
If you develop any of the symptoms of iGAS contact your GP or seek medical advice immediately. Tell your GP that you have been in contact with someone with invasive GAS and that you have developed some symptoms that you are worried about.
It is very likely that your GP will ask you to come into the surgery so you can be examined. If you are too unwell to visit the surgery or it is closed, do not delay seeking medical advice and contact NHS111 or visit https://111.nhs.uk
