Saturday, December 9, 2023
| Term | Definition |
|---|---|
| Invasive group A Streptococcus (iGAS) infection | Isolation of GAS from a normally sterile site, either by PCR or culture. For this study, iGAS also includes GAS infections in which GAS was isolated from a normally nonsterile site in combination with a severe clinical presentation, such as streptococcal toxic shock syndrome or necrotizing fasciitis |
| Group A Streptococcus (GAS) infection | Isolation of GAS from a non-sterile site in combination with clinical symptoms attributable to bacterial infection including fever (temperature ≥38°C), sore throat, wound infection, or cellulitis |
| Group A Streptococcus carriage | Isolation of GAS from a nonsterile site but no symptoms attributable to infection with this microorganism |
| Home healthcare (HHC) | Community health services, including district nursing teams, general practitioners, podiatry (chiropody), community midwifery, hospital outreach, and palliative care, which provide medical or nursing care within a patient’s home |
| Residential care | Live-in accommodation that provides 24-hour care and support to its residents |
Table 1. Definitions used in a study of invasive group A Streptococcus infection associated with home healthcare, England, 2018–2019
| Outbreak no. | No. iGAS cases | No. GAS cases† | No. deaths | No. days from first to last case | No. cases without identified HHC input | emm type | WGS |
|---|---|---|---|---|---|---|---|
| 1 | 14 | 2 | 2 | 136 | 1 | 87 | N |
| 2 | 7 | 1 | 2 | 148 | 0 | 94 | N |
| 3 | 6 | 0 | 3 | 222 | 0 | 94 | Y |
| 4 | 7 | 0 | 2 | 388 | 0 | 89 | Y |
| 5 | 5 | 5 | 2 | 179 | 2 | 89 | N |
| 6 | 3 | 0 | 0 | 75 | 0 | 1 | Y |
| 7 | 4 | 0 | 0 | 219 | 0 | 1 | Y |
| 8 | 2 | 0 | 1 | 3 | 0 | 89 | Y |
| 9 | 9 | 1 | 1 | 507 | 0 | 89 | Y |
| 10 | 39 | 95 | 15 | 487 | 1 | 44 | Y |
| Total | 96 | 104 | 28 | NA | 4 | NA | NA |
Table 2. Summary of home healthcare–associated invasive group A Streptococcus infection outbreaks, England, 2018–2019*
*GAS, group A Streptococcus; HHC, home healthcare; iGAS, invasive group A Streptococcus; NA, not applicable; WGS, whole-genome sequencing. †Noninvasive GAS was not systematically investigated or recorded in all outbreaks. Available data did not enable distinction between carriage and noninvasive infection.
| Characteristics | No. (%) | IQR (range) |
|---|---|---|
| All outbreaks, n = 10 | ||
| Total cases | 96 (100) | NA |
| Total deaths | 28 (29) | NA |
| Median cases | 7 | 4–9 (2–39) |
| Median outbreak duration, d | 199 | 139–347 (3–507) |
| Outbreaks with case data, n = 9 | ||
| Case-patient characteristics, n = 57 | ||
| Median age, y | 83 | 77–90 (42–100) |
| Sex | ||
| F | 39 (68) | NA |
| M | 18 (32) | NA |
| Median days between cases | 21 | 6–46 (1–225) |
| Type of residence, n = 48 | ||
| Residential care | 17 (35) | NA |
| Own home | 31 (65) | NA |
| HHCW exposure, n = 96 | ||
| Patient receiving care | 92 (96) | NA |
| Household contact of recipient | 2 (4) | NA |
| None identified† | 2 (4) | NA |
Table 3. Characteristics of home healthcare–associated invasive group A Streptococcus infection outbreaks, England, 2018–2019*
*HHCW, home healthcare worker; NA, not applicable.
†Cases linked to outbreaks through whole-genome sequencing but without any identified connection to home healthcare services.
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