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The management of an invasive Group A Streptococcus outbreak in the community

Health protection case study

Health Protection Teams (HPTs) across England are responsible for the surveillance, prevention and control of communicable disease and non-infectious environmental hazards. Your local HPT helps to reduce the effect of diseases by managing reported cases and outbreaks of infectious diseases.

HPTs also provide support to health professionals, including:

  • local disease surveillance
  • alert systems
  • investigating and managing health protection incidents
  • national and local action plans for infectious diseases.

Background and epidemiological Information

The North East & North Central London HPT were notified of five elderly patients living within a 2 square mile radius who were admitted to local hospitals with severe group A streptococcal cellulitis and septicaemia. Molecular typing confirmed four patients for whom typing results were available to have the same emm gene sequence type, emm st89.0. This means that all four patients were most likely to be exposed by the same source. An outbreak investigation was launched and identified that each patient had received care interventions from the same district nursing team at their home or local health clinic in the 7 days prior to onset of symptoms.

Management of the situation

Being the iGAS lead for the Health Protection Team I was the Incident lead for this outbreak and my role was to obtain the background of the incident and declare an outbreak. I invited a number of stakeholders to incident meetings and such stakeholders included

  • Infection Control Teams
  • District Nursing Team
  • Occupational Health
  • Public Health Teams,
  • ocal Microbiology Department
  • Public Health England Reference laboratory.

It was my role to gather microbiological, environmental and epidemiological evidence to try and find and eliminate the source. There was strong evidence for a common source in the District Nursing team and appropriate public health actions were taken by swabbing the nursing teams and providing them with antibiotic treatment to prevent further transmission in the community.

Reflection and outcome

The outbreak control team was successful in preventing onward transmission in elderly patients requiring care from the local district nursing team. All the nurses in the team did not show any signs of infection and were treated with antibiotics successfully. Upon reflection I learned both the theory and practical behind outbreak management and now know the role of the Health Protection Team within an outbreak setting. As nurses it is important we learn and understand the methods of an outbreak investigation and know how to face challenges in an outbreak investigation such as delayed communication and managing levels of anxiety within the community.

Lessons for the future

This was one of the first outbreaks I managed as a health protection nurse specialist, having the practical experience will assist in future outbreaks or incidences that I have to manage. I also had the opportunity to reflect on my involvement in the outbreak by writing articles that have been published in the Journal of Infection Prevention as well as the Lancet. Leading on this outbreak also expanded my role as iGAS lead for the team as I am now iGAS lead for London and have been involved in the changes to managing iGAS cases on a national level.

Page last updated - 12/10/2019