Outbreak Tied to Invasive Group A Streptococcal Infection Leads to 12 Deaths in England

An outbreak of invasive Group A streptococcal disease (iGAS) in the United Kingdom has led to at least 12 deaths, British public health authorities announced this week.

According to a press release issued by England’s National Health Service, there have been 32 confirmed cases of the rare bacterial infection in southeastern England’s Mid Essex, mostly among elderly individuals receiving chronic wound care in either their own homes or long-term care facilities. Twelve people have died, the agency confirmed.

“The NHS in Essex is working closely with Public Health England and other partners to manage this local incident, and extra infection control measures have been put in place to prevent the infection spreading in the area,” Rachel Hearn, director of Nursing and Quality with the Mid Essex Clinical Commissioning Group, said in the press release.

Group A streptococcus bacteria can be found in the throat and on the skin and will not cause illness for most healthy people. Most Group A streptococcus infections cause relatively mild illnesses such as strep throat, scarlet fever, or a skin infection, according to the National Health Service. On rare occasions, the bacteria can enter the bloodstream with severe and potentially deadly consequences (invasive Group A streptococcal disease).

“The risk of contracting iGAS is very low for the vast majority of people and treatment with antibiotics is very effective if started early,” Hearn said. “We will continue to work with our partners in Public Health England to investigate how this outbreak occurred and take every possible step to ensure our local community is protected.”

A Public Health England report on Group A streptococcal infection seasonal activity published in May urged health care providers to remain vigilant.

“Clinicians, microbiologists and [health protection teams] should continue to be mindful of potential increases in invasive disease and maintain a high index of suspicion in relevant patients as early recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection can be life-saving.”

In a recent study, investigators sequenced thousands of genomes and found a common gene signature in nearly all Group A streptococcus strains, bringing a vaccine 1 step closer to reality. The research was conducted over 10 years in more than 20 countries by the Peter Doherty Institute for Infection and Immunity, the Wellcome Sanger Institute in the UK, and the University of Queensland.

“It is important to know that Strep A is a genetically diverse pathogen and that there are hundreds of Strep A lineages circulating throughout the world that can cause serious infections in humans,” lead author Mark Davies, PhD, Doherty-Sanger Fellow at the Doherty Institute and the Wellcome Sanger Institute, told Contagion®. “In the context of vaccine design, our study identifies that there are a number of proposed Strep A vaccine antigens that are carried by >99% of these genetically diverse Strep A lineages. The use of conserved vaccine antigens is key in the objective of reducing Strep A infections in both high and low-middle income settings.”