OBJECTIVES: The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore important; but is unclear how best to manage these incidents. We attempted to identify which control measures are most likely to be effective. METHODS: We undertook literature searches using PubMed and Google Scholar and contacted colleagues in Health Protection Units in England for unpublished outbreaks. RESULTS: We identified 31 outbreaks; of which 20 had sufficient detail for further analysis. Overall carriage rates of GAS in care home residents identified in outbreak investigations were 4.7%, and in staff 3.2%. In 8 outbreaks mass antibiotic prophylaxis was offered, in 9 selective prophylaxis only and in 3 none at all. Surveillance swabbing had limited influence on decisions regarding prophylaxis. A few papers mentioned the role of environmental contamination and the risk from an affected roommate. CONCLUSIONS: Pooling of results from these outbreaks failed to suggest any clear advantage to either a selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data collection from future outbreaks could be of benefit in informing future policy.
OBJECTIVES: The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore important; but is unclear how best to manage these incidents. We attempted to identify which control measures are most likely to be effective. METHODS: We undertook literature searches using PubMed and Google Scholar and contacted colleagues in Health Protection Units in England for unpublished outbreaks. RESULTS: We identified 31 outbreaks; of which 20 had sufficient detail for further analysis. Overall carriage rates of GAS in care home residents identified in outbreak investigations were 4.7%, and in staff 3.2%. In 8 outbreaks mass antibiotic prophylaxis was offered, in 9 selective prophylaxis only and in 3 none at all. Surveillance swabbing had limited influence on decisions regarding prophylaxis. A few papers mentioned the role of environmental contamination and the risk from an affected roommate. CONCLUSIONS: Pooling of results from these outbreaks failed to suggest any clear advantage to either a selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data collection from future outbreaks could be of benefit in informing future policy.
Authors: Nick Bundle; Laura Bubba; Juliana Coelho; Rachel Kwiatkowska; Rachel Cloke; Sarah King; Jill Rajan-Iyer; Max Courtney-Pillinger; Charles R Beck; Vivian Hope; Theresa Lamagni; Colin S Brown; Daiga Jermacane; Rachel Glass; Monica Desai; Maya Gobin; Sooria Balasegaram; Charlotte Anderson Journal: Euro Surveill Date: 2017-01-19
Authors: Maria Drayß; Heike Claus; Kerstin Hubert; Katrin Thiel; Anja Berger; Andreas Sing; Mark van der Linden; Ulrich Vogel; Thiên-Trí Lâm Journal: PLoS One Date: 2019-02-08 Impact factor: 3.240
Authors: Victoria J Chalker; Alyson Smith; Ali Al-Shahib; Stella Botchway; Emily Macdonald; Roger Daniel; Sarah Phillips; Steven Platt; Michel Doumith; Rediat Tewolde; Juliana Coelho; Keith A Jolley; Anthony Underwood; Noel D McCarthy Journal: Emerg Infect Dis Date: 2016-06 Impact factor: 6.883
Authors: P A Pilon; N Savard; J Aho; J Caron; A Urbanek; R Paré; P Le Guerrier; C Savard; K Hammond-Collins; C Dung Tran; R Allard; M C Domingo Journal: Can Commun Dis Rep Date: 2019-01-03