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Table 1.  

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

Table 2.  

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.

Table 3.  

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.

CME / ABIM MOC

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

  • Authors: Laura E. Nabarro, FRCPath; Colin S. Brown, MD, FRCPath; Sooria Balasegaram, MBChB; Valérie Decraene, PhD; James Elston, FFPH; Smita Kapadia, MBBS; Pauline Harrington, MSc; Peter Hoffman, BSc; Rachel Mearkle, MBBS; Bharat Patel, MD, FRCPath; Derren Ready, PhD; Esther Robinson, MD, FRCPath; Theresa Lamagni, PhD
  • CME / ABIM MOC Released: 4/18/2022
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 4/18/2023, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for primary care physicians, infectious disease specialists, and other physicians who treat and manage frail patients at risk for invasive group A Streptococcus.

The goal of this activity is to evaluate the source, outcomes, and infection control measures in outbreaks of invasive group A Streptococcus.

Upon completion of this activity, participants will:

  • Analyze characteristics of invasive group A Streptococcus
  • Evaluate demographics and outcomes of the current study of invasive group A Streptococcus outbreaks
  • Assess the source of invasive group A Streptococcus outbreaks based on investigations
  • Distinguish infection control measures employed during invasive group A Streptococcus outbreaks


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Faculty

  • Laura E. Nabarro, FRCPath

    Public Health England, London, United Kingdom

  • Colin S. Brown, MD, FRCPath

    Public Health England, London, United Kingdom

  • Sooria Balasegaram, MBChB

    Public Health England, London, United Kingdom

  • Valérie Decraene, PhD

    Public Health England, London, United Kingdom

  • James Elston, FFPH

    Public Health England, London, United Kingdom

  • Smita Kapadia, MBBS

    Public Health England, London, United Kingdom

  • Pauline Harrington, MSc

    Public Health England, London, United Kingdom

  • Peter Hoffman, BSc

    Public Health England, London, United Kingdom

  • Rachel Mearkle, MBBS

    Public Health England, London, United Kingdom

  • Bharat Patel, MD, FRCPath

    Public Health England, London, United Kingdom

  • Derren Ready, PhD

    Public Health England, London, United Kingdom

  • Esther Robinson, MD, FRCPath

    Public Health England, London, United Kingdom

  • Theresa Lamagni, PhD

    Public Health England, London, United Kingdom

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California

    Disclosures

    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline; Johnson & Johnson

Editor

  • Amy J. Guinn, BA, MA

    Copyeditor
    Emerging Infectious Diseases

    Disclosures

    Disclosure: Amy J. Guinn, BA, MA, has disclosed no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Disclosure: Amanda Jett, PharmD, BCACP, has disclosed no relevant financial relationships.


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CME / ABIM MOC

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

Authors: Laura E. Nabarro, FRCPath; Colin S. Brown, MD, FRCPath; Sooria Balasegaram, MBChB; Valérie Decraene, PhD; James Elston, FFPH; Smita Kapadia, MBBS; Pauline Harrington, MSc; Peter Hoffman, BSc; Rachel Mearkle, MBBS; Bharat Patel, MD, FRCPath; Derren Ready, PhD; Esther Robinson, MD, FRCPath; Theresa Lamagni, PhDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC Released: 4/18/2022

Valid for credit through: 4/18/2023, 11:59 PM EST

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References

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  17. Mahida N, Beal A, Trigg D, Vaughan N, Boswell T. Outbreak of invasive group A streptococcus infection: contaminated patient curtains and cross-infection on an ear, nose and throat ward. J Hosp Infect. 2014;87:141–4.
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