1887
Outbreaks Open Access
Like 0

Abstract

An out-of-season increase in cases of invasive Group A streptococcus (iGAS) was observed in Ireland between October 2022 and August 2023. We describe the management of an iGAS outbreak involving three nursing home residents in Ireland in early 2023. A regional Department of Public Health was notified of an iGAS case in a nursing home resident in January 2023. When two further cases among residents were notified 7 days later, an outbreak was declared. Surveillance for GAS/iGAS infection in residents and staff was undertaken. The site was visited to provide infection prevention and control (IPC) support. Isolates were typed. A total of 38 residents and 29 staff in contact with resident cases were provided with antibiotic chemoprophylaxis. Seven additional staff with no direct resident contact also received chemoprophylaxis after finding one probable localised GAS infection among them. No more iGAS cases subsequently occurred.Site visit recommendations included advice on terminal cleaning and cleaning of shared equipment, as well as strengthening staff education on hand hygiene and masking. All isolates were of subtype 18.12, a subtype not previously detected in Ireland. Key outbreak control measures were rapid delivery of IPC support and chemoprophylaxis. 18 is infrequently associated with GAS infections.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2024.29.17.2300609
2024-04-25
2024-12-22
/content/10.2807/1560-7917.ES.2024.29.17.2300609
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/29/17/eurosurv-29-17_4.html?itemId=/content/10.2807/1560-7917.ES.2024.29.17.2300609&mimeType=html&fmt=ahah

References

  1. O’Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. , Active Bacterial Core Surveillance Team. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis. 2007;45(7):853-62.  https://doi.org/10.1086/521264  PMID: 17806049 
  2. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685-94.  https://doi.org/10.1016/S1473-3099(05)70267-X  PMID: 16253886 
  3. Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control. Pathogens. 2021;10(2):248.  https://doi.org/10.3390/pathogens10020248  PMID: 33671684 
  4. Bagcchi S. Surge of invasive Group A streptococcus disease. Lancet Infect Dis. 2023;23(3):284.  https://doi.org/10.1016/S1473-3099(23)00043-9  PMID: 36669511 
  5. HSE Health Protection Surveillance Centre (HPSC). Latest update on the 2022-2023 upsurge in invasive Group A streptococcus (iGAS) infections in Ireland. Dublin: HPSC; 2023. Available from: https://www.hpsc.ie/news/newsarchive/2023newsarchive/title-22663-en.html#:~:text=Between%202nd%20October%202022%20and,in%20children%20aged%20%3C18%20years
  6. United Kingdom Health Security Agency (UKHSA). UK guidelines for the management of contacts of invasive group A streptococcus (iGAS) infection in community settings. London: UKHSA; 2022. Available from: https://assets.publishing.service.gov.uk/media/64071ec5d3bf7f25fa417a91/Management-of-contacts-of-invasive-group-a-streptococcus.pdf
  7. HSE Health Protection Surveillance Centre (HPSC). Case Definition for Invasive Group A Streptococcal Infection (iGAS). Dublin: HPSC; 2022. Available from: https://www.hpsc.ie/a-z/other/groupastreptococcaldiseasegas/casedefinition/
  8. HSE Health Protection Surveillance Centre (HPSC). Algorithm 1: Management of contacts of a case of iGAS in a Household setting Version 2.1 13/01/2023. Dublin: HPSC; 2023. Available from: https://www.hpsc.ie/a-z/other/groupastreptococcaldiseasegas/guidance/ManagementofContactsiGAScaseAlgo.pdf
  9. Testing. TECoAS. Breakpoint tables for interpretation of MICs and zone diameters, version 13.0. 2023. Available from: https://www.eucast.org/clinical_breakpoints
  10. Meehan M, Murchan S, Gavin PJ, Drew RJ, Cunney R. Epidemiology of an upsurge of invasive group A streptococcal infections in Ireland, 2012-2015. J Infect. 2018;77(3):183-90.  https://doi.org/10.1016/j.jinf.2018.05.010  PMID: 29935196 
  11. Croucher NJ, Page AJ, Connor TR, Delaney AJ, Keane JA, Bentley SD, et al. Rapid phylogenetic analysis of large samples of recombinant bacterial whole genome sequences using Gubbins. Nucleic Acids Res. 2015;43(3):e15.  https://doi.org/10.1093/nar/gku1196  PMID: 25414349 
  12. HSE Health Protection Surveillance Centre (HPSC). Public Health & Infection Prevention & Control Guidelines on Prevention and Management of Cases and Outbreaks of COVID-19, Influenza & other Respiratory Infections in Residential Care Facilities V1.12 17.07.2023. Dublin: HPSC; 2023. Available from: https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/residentialcarefacilities/IPC%20and%20PH%20guidance%20for%20outbreaks.pdf
  13. HSE Health Protection Research and Guideline Development Unit (HPSC). Choice of agent for chemoprophylaxis for a contact of Group A streptococcus case Version 1.0. Dublin: HPSC; 2022. Available from: https://www.hpsc.ie/a-z/other/groupastreptococcaldiseasegas/guidance/ChoiceOfChemoprophylaxisAgent.pdf
  14. Brouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023;21(7):431-47.  https://doi.org/10.1038/s41579-023-00865-7 
  15. Guy R, Henderson KL, Coelho J, Hughes H, Mason EL, Gerver SM, et al. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill. 2023;28(1):2200942.  https://doi.org/10.2807/1560-7917.ES.2023.28.1.2200942  PMID: 36695450 
  16. de Gier B, Marchal N, de Beer-Schuurman I, Te Wierik M, Hooiveld M, de Melker HE, et al. , ISIS-AR Study Group, GAS Study group, Members of the GAS study group, Members of the ISIS-AR study group. Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. Euro Surveill. 2023;28(1):2200941.  https://doi.org/10.2807/1560-7917.ES.2023.28.1.2200941  PMID: 36695447 
  17. HSE Health Protection Surveillance Centre (HPSC). Invasive Group A Streptococcal Disease in Ireland, 2018. Dublin: HPSC; 2019. Available from: https://www.hpsc.ie/a-z/other/groupastreptococcaldiseasegas/surveillancereports/Invasive%20Group%20A%20Streptococcal%20disease%20in%20Ireland%202018.pdf
  18. HSE Health Protection Surveillance Centre (HPSC). Infectious Disease Notifications in Ireland, 2019 - 2023. Dublin: HPSC; 2024. Available from: https://www.hpsc.ie/notifiablediseases/annualidstatistics/Annual_ID_Summary_Report_for_HPSC_Web_v8.0-20219-2023-01022024.pdf
  19. Saavedra-Campos M, Simone B, Balasegaram S, Wright A, Usdin M, Lamagni T. Estimating the risk of invasive group A Streptococcus infection in care home residents in England, 2009-2010. Epidemiol Infect. 2017;145(13):2759-65.  https://doi.org/10.1017/S0950268817001674  PMID: 28805176 
  20. Rainbow J, Jewell B, Danila RN, Boxrud D, Beall B, Van Beneden C, et al. Invasive group a streptococcal disease in nursing homes, Minnesota, 1995-2006. Emerg Infect Dis. 2008;14(5):772-7.  https://doi.org/10.3201/eid1405.0704072  PMID: 18439360 
  21. Auerbach SB, Schwartz B, Williams D, Fiorilli MG, Adimora AA, Breiman RF, et al. Outbreak of invasive group A streptococcal infections in a nursing home. Lessons on prevention and control. Arch Intern Med. 1992;152(5):1017-22.  https://doi.org/10.1001/archinte.1992.00400170099019  PMID: 1580705 
  22. Cummins A, Millership S, Lamagni T, Foster K. Control measures for invasive group A streptococci (iGAS) outbreaks in care homes. J Infect. 2012;64(2):156-61.  https://doi.org/10.1016/j.jinf.2011.11.017  PMID: 22138601 
  23. Khan F, Bai Z, Kelly S, Skidmore B,, Dickson C,, Nunn A,, et al. Effectiveness and Safety of Antibiotic Prophylaxis for Persons Exposed to Cases of Invasive Group A Streptococcal Disease: A Systematic Review. Open Forum Infect Dis. 2022;9(8):ofac244.  https://doi.org/10.1016/j.jinf.2011.11.017  PMID: 22138601 
  24. Sarangi J, Rowsell R. A nursing home outbreak of group A streptococcal infection: case control study of environmental contamination. J Hosp Infect. 1995;30(2):162-4.  https://doi.org/10.1016/0195-6701(95)90160-4  PMID: 7673692 
  25. Schwartz B, Elliott JA, Butler JC, Simon PA, Jameson BL, Welch GE, et al. Clusters of invasive group A streptococcal infections in family, hospital, and nursing home settings. Clin Infect Dis. 1992;15(2):277-84.  https://doi.org/10.1093/clinids/15.2.277  PMID: 1520763 
  26. Jordan HT, Richards CL Jr, Burton DC, Thigpen MC, Van Beneden CA. Group A streptococcal disease in long-term care facilities: descriptive epidemiology and potential control measures. Clin Infect Dis. 2007;45(6):742-52.  https://doi.org/10.1086/520992  PMID: 17712760 
  27. Efstratiou A, Lamagni T. Epidemiology of Streptococcus pyogenes. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2022.
  28. Gherardi G, Vitali LA, Creti R. Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000. Front Public Health. 2018;6:59.  https://doi.org/10.3389/fpubh.2018.00059  PMID: 29662874 
  29. Gaibani P, Scaltriti E, Foschi C, Baggio E, Tamburini MV, Creti R, et al. Matrix-assisted laser desorption ionization-time of flight and comparative genomic analysis of M-18 group a Streptococcus strains associated with an acute rheumatic fever outbreak in northeast Italy in 2012 and 2013. J Clin Microbiol. 2015;53(5):1562-72.  https://doi.org/10.1128/JCM.03465-14  PMID: 25740772 
  30. Smoot JC, Korgenski EK, Daly JA, Veasy LG, Musser JM. Molecular analysis of group A Streptococcus type emm18 isolates temporally associated with acute rheumatic fever outbreaks in Salt Lake City, Utah. J Clin Microbiol. 2002;40(5):1805-10.  https://doi.org/10.1128/JCM.40.5.1805-1810.2002  PMID: 11980963 
  31. Kim S, Lee NY. Epidemiology and antibiotic resistance of group A streptococci isolated from healthy schoolchildren in Korea. J Antimicrob Chemother. 2004;54(2):447-50.  https://doi.org/10.1093/jac/dkh363  PMID: 15269193 
  32. Hraoui M, Boutiba-Ben Boubaker I, Doloy A, Samir E, Ben Redjeb S, Bouvet A. Epidemiological markers of Streptococcus pyogenes strains in Tunisia. Clin Microbiol Infect. 2011;17(1):63-8.  https://doi.org/10.1111/j.1469-0691.2010.03174.x  PMID: 20132259 
  33. Walkinshaw DR, Wright MEE, Mullin AE, Excler JL, Kim JH, Steer AC. The Streptococcus pyogenes vaccine landscape. NPJ Vaccines. 2023;8(1):16.  https://doi.org/10.1038/s41541-023-00609-x  PMID: 36788225 
  34. Hurst JR, Shannon BA, Craig HC, Rishi A, Tuffs SW, McCormick JK. The Streptococcus pyogenes hyaluronic acid capsule promotes experimental nasal and skin infection by preventing neutrophil-mediated clearance. PLoS Pathog. 2022;18(11):e1011013.  https://doi.org/10.1371/journal.ppat.1011013  PMID: 36449535 
  35. Proft T, Fraser JD. Streptococcal superantigens: biological properties and potential role in disease. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations. 2nd edition. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2022.
/content/10.2807/1560-7917.ES.2024.29.17.2300609
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error