Background
Outbreaks of invasive GAS infection in community healthcare patients now outnumber those in any other setting or at-risk population in England. We present our experience in managing one such outbreak.
Methods
Cases were identified from laboratory surveillance, hospital notification, and submission of isolates to the national reference laboratory and defined as part of the outbreak if they received community nursing in Suffolk during the period at risk, or epidemiologically linked to another case, and typed as emm11. Whole genome sequencing (WGS) was used to explore relatedness.
Results
A total of 92 confirmed cases (13 invasive and 79 non-invasive) were identified from August 2023 to January 2025. 70 cases were receiving community nursing care and 15 were secondary cases resident in a setting where care was delivered; 6 were health/social care staff identified through screening or testing of symptomatic staff. With the exclusion of staff, cases resided in 57 settings across 4 local authorities, 39 in care homes and 47 in private homes. WGS analysis identified cases to be within 4 SNPs of another case. The majority (57/63) were resistant to clarithromycin, clindamycin, and tetracycline. Initiatives to improve clinical management of wound infections, active case finding, IPC review and targeted antibiotic prophylaxis were implemented, after which a decline in case numbers was seen. 4 deaths where GAS infection contributed to death were identified.
Conclusion
This outbreak highlighted the potential for widespread dissemination of GAS infection through community healthcare services and the need for further research to identify effective control measures.