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Group A Streptococcus (iGAS) outbreak in mid and west Essex

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Latest Update – 29 October 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Since the last update on 22 October 2019, there have been no further cases of iGAS within mid and west Essex. The total number of people affected by the iGAS outbreak remains at 39, with 33 cases confirmed as part of this outbreak and six probable cases. Fifteen people have sadly died. Our thoughts are with the families of those patients who have passed away.

Future updates

Since June 2019, weekly updates have been posted on Mid Essex CCG’s website to keep patients, residents and stakeholders informed about the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex. As there has been no new information to share for a number of weeks, the Incident Management team will now only be posting updates on Mid Essex CCG’s website when updated information is available.

Advice for the public and helpline

The local Freephone helpline number, 03000 032124, will continue to operate and is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. The helpline is now being answered by Mid Essex CCG colleagues.

Update – 22 October 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Since the last update on 15 October 2019, there have been no further cases of iGAS within mid and west Essex

The total number of people affected by the iGAS outbreak remains at 39, with 33 cases confirmed as part of this outbreak and six probable cases. Fifteen people have sadly died. Our thoughts are with the families of those patients who have passed away.

Background:

Those affected within this iGAS outbreak are older people in Braintree District and the neighbouring area in West Essex, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

Earlier in July 2019, Public Health England undertook Whole Genome Sequencing to investigate differences and similarities in the DNA sequence of the iGAS bacteria collected from patients within the mid Essex outbreak. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample.

The Whole Genome Sequencing confirmed that the single case of iGAS in Basildon in 2018 and single case of iGAS in Southend in February 2019, previously thought to be part of the mid Essex outbreak, are not. These two cases appear to be isolated cases of iGAS that can arise in the community and have now been removed from the outbreak investigation. Since the two cases in west Essex were identified, samples from these cases were analysed using Whole Genome Sequencing to check if they were part of this outbreak and this process has confirmed that they are linked to the outbreak in mid Essex.

Incident management team and control measures

The incident management team continues to monitor the control measures advised nationally by Public Health England which are already in place, to limit the spread of this infection. These include:

  • A programme of preventative antibiotics for the community nursing staff.

  • Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.

  • A deep clean of all community nurse bases in mid Essex has been completed. The reinforcement of standard infection control measures including hand hygiene and use of personal protective equipment among staff continues.

  • Samples are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.

  • In West Essex, Public Health England has recommended enhanced infection prevention control measures which include swabbing and testing of staff and patients linked to the newly affected cases in the West Essex area. Following these tests, Public Health England will be advising about any further control measures which need to be implemented in West Essex where patients are affected by iGAS.

Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. The helpline is now being answered by Mid Essex CCG colleagues. 

Frequently asked questions:

What is Group A Streptococcus (GAS)?
GAS is a bacterium, full name Streptococcus pyogenes, it is sometimes found in the throat or on the skin and usually causes no symptoms.
How are GAS infections spread?

GAS is spread by contact or by droplets from the respiratory tract, when sneezing or coughing. People may carry GAS in their throat or on their skin, which would make them a carrier, also referred to as colonised. Carriers often have no symptoms of illness.

What infections are caused by GAS?
Most GAS infections result in illnesses such as a sore throat (this can be called ’strep throat’) or a skin infection such as impetigo or scarlet fever. On rare occasions, these bacteria can cause other more severe diseases, for example blood stream infections (septicaemia).

What is invasive group A streptococcal (iGAS)?
iGAS is rare but serious. It can occur when bacteria gets into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are called invasive GAS. In the current outbreak patients with iGAS have suffered septicaemia (blood stream) infection.

What are the signs and symptoms of invasive Group A Streptococcal?

  • High fever
  • Severe muscle aches
  • Pain in one area of the body
  • Redness at the site of a wound
  • Vomiting or diarrhoea

What should I do if I think I have any of the symptoms of iGAS?
If you develop any of the symptoms of iGAS contact your GP or seek medical advice immediately. Tell your GP that you have been in contact with someone with invasive GAS and that you have developed some symptoms that you are worried about.

It is very likely that your GP will ask you to come into the surgery so you can be examined. If you are too unwell to visit the surgery or it is closed, do not delay seeking medical advice and contact NHS111 or visit https://111.nhs.uk

Update - 15 October 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Since the last update on 8 October 2019, there have been no further cases of iGAS within mid and west Essex. The total number of people affected by the iGAS outbreak remains at 39, with 33 cases confirmed as part of this outbreak and six probable cases. Fifteen people have sadly died. Our thoughts are with the families of those patients who have passed away.

Update - 8 October 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Since the last update, there have been no further cases of iGAS within mid and west Essex. The total number of people affected by the iGAS outbreak remains 39, with 33 cases confirmed as part of this outbreak and six probable cases. Fifteen people have sadly died. Our thoughts are with the families of those patients who have passed away. 

Update – 1 October 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Since the last update, the Incident Management team has learned of two additional, historical cases which will remain probable and date back to the end of 2018. They were identified following a thorough review of all iGAS cases on laboratory databases, using patient data from Provide Community Interest Company, who provide the majority of our community services in mid Essex. Sadly one of these patients died in 2018.

The review was conducted by Public Health England to make sure all cases of iGAS dating back 18 months had been investigated for a potential link to the outbreak in mid Essex. The two additional patients, including the patient who sadly died, are both from mid Essex and were receiving treatment for wounds in their own home or in a care home.

Therefore the total number of people affected by the iGAS outbreak is 39, with 33 cases confirmed as part of this outbreak and six probable cases. Fifteen people have sadly died. Our thoughts are with the families of those patients who have passed away.

Update - 24 September 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 24 September, there have been no further cases of iGAS. The total number of people affected by the iGAS outbreak remains the same at 37, with 33 cases confirmed as part of this outbreak and four probable cases. Fourteen people have sadly died.

Update - 17 September 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 17 September, there have been no further cases of iGAS. The total number of people affected by the iGAS outbreak is unchanged at 37, with 33 cases confirmed as part of this outbreak and four probable cases. Fourteen people have sadly died.

Update – 10 September 2019

This brief provides an update on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

Following regular communications with the patients and their families affected by this outbreak, we have been informed that a patient in mid Essex who had previously been treated for iGAS earlier in the year has sadly died. Our thoughts are with their family.

We are reporting this retrospectively having completed investigations to conclude that their death is linked to this outbreak. To protect patient confidentiality we are unable to confirm when they had iGAS or when they passed away.

This means that of the 37 people affected by iGAS, 33 are confirmed as part of this outbreak and four are probable cases. Fourteen people have sadly died.

Update - 3 September 2019

This brief provides an update on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 3 September, there have been no further cases of iGAS and the total number of people affected by the iGAS outbreak is unchanged at 37. However following tests by Public Health England, the mid Essex patient whose results were pending last week has now been confirmed as part of this outbreak. This means that of the 37 people affected by iGAS, 33 are confirmed as part of this outbreak and four are probable cases. Thirteen people have sadly died.

Update – 27 August 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 27 August, NHS Mid Essex Clinical Commissioning Group (CCG) has been informed of one new probable case of iGAS in mid Essex. Test results from this patient are pending which is why this case has been defined as a probable case at the current time. As a result, the total number of people affected by the iGAS outbreak is now 37, with 32 cases confirmed as part of this outbreak and five probable cases. Thirteen people have sadly died.

The patients affected are older people in Braintree District and the neighbouring area in West Essex, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes. 

Update - 20 August 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 20 August, there have been no further cases of iGAS. The total number of people affected by the iGAS outbreak is unchanged at 36, with 32 cases confirmed as part of this outbreak and four probable cases. Thirteen people have sadly died.

The patients affected are older people in Braintree District and the neighbouring area in west Essex, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

Update - 13 August 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 13 August, NHS Mid Essex Clinical Commissioning Group (CCG) has been informed of one new probable case of iGAS in mid Essex. As a result, the total number of people affected by the iGAS outbreak is now 36, with 32 cases confirmed as part of this outbreak and four probable cases. Thirteen people have sadly died.

The patients affected are older people in Braintree District and the neighbouring area in West Essex, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

Update - 6 August 2019

This update provides the latest information on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of 6 August, there have been no further cases of iGAS. The total number of people affected by the iGAS outbreak is unchanged at 35, with 32 cases confirmed as part of this outbreak and three probable cases. Thirteen people have sadly died.

The patients affected are older people in Braintree District and the neighbouring area in west Essex, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

Whole Genome Sequencing of cases in West Essex

As part of the investigation, Public Health England has undertaken Whole Genome Sequencing of the GAS bacteria found in patients within the outbreak. Since the two cases in west Essex were identified, samples from these cases were analysed to check if they were part of this outbreak and this process has confirmed that they are linked to the outbreak in mid Essex.

Whole Genome Sequencing is used within a Public Health laboratory setting to investigate differences and similarities in the DNA sequence of bacteria. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample collected from patients within this outbreak.

Control measures in West Essex

NHS Mid Essex CCG continues to work closely with NHS West Essex CCG and partners including Public Health England (which is advising on measures to prevent the infection spreading) and Essex Partnership University Trust (EPUT), which provides community nursing services in West Essex, to monitor and investigate the cases of iGAS in West Essex.

 

Update - 30 July 2019

Update on IGAS cases

This brief provides an update on the invasive Group A Streptococcus (iGAS) outbreak in mid and west Essex.

As of July 30, there have been no further cases of iGAS and the total number of people affected by the iGAS outbreak is unchanged at 35. However following tests by Public Health England, the mid Essex patient whose results were pending last week has now been confirmed as a part of this outbreak. This means that of the 35 people affected by iGAS, 32 are confirmed as part of this outbreak and three are probable cases. Thirteen people have sadly died.

The patients affected are older members of the community receiving treatment for wounds in care homes or in their own homes.

Control measures in West Essex

NHS Mid Essex CCG has been working closely with NHS West Essex CCG and partners including Public Health England (whose role is to advise health organisations on measures they can take to prevent an infection spreading) and Essex Partnership University Trust (EPUT), which provides community nursing services in West Essex, to monitor and investigate the cases of iGAS in West Essex.

To ensure we limit the spread of infection, infection prevention control measures are in place and continue to be rigorously applied across the area. Public Health England has recommended enhanced control measures which include swabbing and testing of staff and patients linked to the newly affected cases in the West Essex area.

Independent investigation

NHS Mid Essex CCG continues to lead an incident management team for the outbreak and as is usual practice in the NHS has additionally requested, under the NHS Serious Incident Framework, an independent investigation team to look into the iGAS outbreak. This investigation is likely to take around six months and any lessons learned during the investigation will be shared and implemented throughout the health service.

 

Update - 23 July 2019

NHS Mid Essex Clinical Commissioning Group (CCG) has been informed of one new case of iGAS in mid Essex. In addition, NHS Mid Essex CCG and NHS West Essex CCG have been informed of two cases of iGAS infection within the NHS West Essex CCG boundary. Sadly, one West Essex patient has died.

Following investigation, both of the West Essex patients with iGAS infection have been linked to the mid Essex outbreak. Test results from the mid Essex patient are pending.

The patients affected are older members of the community receiving treatment for wounds in care homes or in their own homes.

As a result of the mid and West Essex cases, the total number of people affected by the iGAS outbreak is now 35 and 13 people have sadly died*.

NHS Mid Essex CCG has set up an incident management team which is working closely with NHS West Essex CCG and partners to manage the outbreak. Public Health England will advise what control measures need to be implemented in West Essex where patients are affected by iGAS.

*Of the 35 patients affected by the iGAS outbreak in mid and West Essex, 31 are confirmed cases and four are probable.

Incident management team and control measures

The incident management team continues to monitor the control measures advised nationally by Public Health England which are already in place, to limit the spread of this infection. These include:

  • A programme of preventative antibiotics for the community nursing staff.

  • Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.

  • A deep clean of all community nurse bases in mid Essex has been completed. The reinforcement of standard infection control measures including hand hygiene and use of personal protective equipment among staff continues.

  • Samples are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.
    Public Health England will advise what control measures need to be implemented in West Essex where patients are affected by iGAS.
    Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. The helpline is now being answered by colleagues at Essex County Council who are supporting Mid Essex CCG and West Essex CCG with answering questions. Updates on the outbreak and West Essex cases will continue to be available at midessexccg.nhs.uk.

 

Update - 16 July 2019

As of July 16, there have been no further cases of iGAS within the mid Essex area.


NHS Mid Essex Clinical Commissioning Group continues to lead the incident management team comprised of Public Health England, Provide Community Interest Company (who provide the majority of our out of hospital services), NHS England and NHS Improvement, to monitor and investigate the existing iGAS outbreak.


As we have mentioned in our previous briefing, the total number of cases is 32* and sadly, 12 of those patients have died. The number of cases reflects Public Health England’s Whole Genome Sequencing Work of the GAS bacteria found in patients within the outbreak. The work found that the iGAS case in Basildon in 2018 and the iGAS case in Southend in February 2019, are not part of the outbreak in mid Essex.


Whole Genome Sequencing is used within a Public Health laboratory setting to investigate differences and similarities in the DNA sequence of bacteria. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample collected from patients within this outbreak. Any further information from the Whole Genome Sequencing work will be shared in future updates.


*Of the 32 patients affected by the iGAS outbreak in mid Essex, 30 are confirmed cases and two are probable.


Background (Updated on 16 July):

Those affected within the iGAS outbreak are older people in Braintree District, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

It was previously thought that the single case of iGAS in Basildon in 2018 and single case of iGAS in Southend in February 2019 could be part of the outbreak in mid Essex. Whole Genome Sequencing of all cases of iGAS identified as part of the outbreak has provided confirmation that the cases in Basildon and Southend are not part of the mid Essex outbreak. These two cases appear to be isolated cases of iGAS that can arise in the community, and have now been removed from the outbreak investigation.

Incident management team and control measures

The incident management team continues to monitor the control measures already in place to limit the spread of this infection. These include:

  • A programme of preventative antibiotics for the community nursing staff in mid Essex

  • Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.

  • A deep clean of all community nurse bases in mid Essex has been completed. The reinforcement of standard infection control measures including hand hygiene and use of personal protective equipment among staff continues.

  • Swabs are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.

Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. Updates will continue to be available at midessexccg.nhs.uk.

 

Update - 9 July 2019

NHS Mid Essex Clinical Commissioning Group, along with partners at Public Health England, Provide Community Interest Company (who provide the majority of our out of hospital services), NHS England and NHS Improvement, are continuing to monitor, assess and investigate the outbreak of invasive Group A Streptococcus (iGAS) infection in mid Essex.

As part of the investigation, Public Health England has undertaken Whole Genome Sequencing of the GAS bacteria found in patients within the outbreak. This work has demonstrated that the iGAS case in Basildon in 2018 and the iGAS case in Southend in February 2019, are not part of the outbreak in mid Essex. Therefore the rest of the cases are linked to the iGAS outbreak in mid Essex. The total number of patients affected is now 32* and sadly, 12 of those patients have died.

Whole Genome Sequencing is used within a Public Health laboratory setting to investigate differences and similarities in the DNA sequence of bacteria. This method allows Public Health England to check which iGAS cases are genetically linked and which are not. This is done by analysing the DNA sequence of each bacterial sample collected from patients within this outbreak. Any further information from the Whole Genome Sequencing work will be shared in future updates.

*Of the 32 patients affected by the iGAS outbreak in mid Essex, 30 are confirmed cases and two are probable.


Background (updated on 9 July):

Those affected within the iGAS outbreak are older people in Braintree District, Chelmsford City and Maldon District. The majority of patients were receiving treatment for wounds, with some in care homes but most in their own homes.

It was previously thought that the single case of iGAS in Basildon in 2018 and single case of iGAS in Southend in February 2019 could be part of the outbreak in mid Essex. Whole Genome Sequencing of all cases of iGAS identified as part of the outbreak has provided confirmation that the cases in Basildon and Southend are not part of the mid Essex outbreak. These two cases appear to be isolated cases of iGAS that can arise in the community, and have now been removed from the outbreak investigation.

Incident management team and control measures

NHS Mid Essex Clinical Commissioning Group is leading an incident management team and is working hard with colleagues to manage the situation. These colleagues include Public Health England, Provide Community Interest Company, who provide the majority of mid Essex community health services, NHS England and NHS Improvement.

The control measures put in place to limit the spread of this infection include:

• A programme of preventative antibiotics for the community nursing staff in mid Essex
• Community nursing teams who usually work within the CM7 postcode area in Braintree are working only in that area for the time being to minimise the risk of the infection spreading. This is because the majority of cases have been within this area of Braintree.
• A deep clean of all community nurse bases in mid Essex and reinforcing standard infection control measures including hand hygiene and use of personal protective equipment among staff continue.
• Swabs are being taken from adult patients being treated by mid Essex community nursing teams to check for the bacteria.

Advice for the public and helpline

The NHS understands this is a worrying time for people and wants to reassure members of the public that the risk of contracting iGAS is very low. Treatment with antibiotics is usually very effective when started early.

The local Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. Updates will continue to be available at midessexccg.nhs.uk.

 

Update - 3 July 2019

As part of the ongoing iGAS outbreak in mid Essex, NHS Mid Essex Clinical Commissioning Group can confirm that a further patient has been diagnosed with iGAS and is currently being treated.

In addition, as part of the monitoring and risk assessments of this outbreak, Public Health England (PHE) have further reviewed how cases are defined in this outbreak to ensure that all appropriate cases are captured and investigated. As a result, an additional case has been added to the total outbreak count. This patient passed away with sepsis earlier this year. The case was previously not included in the iGAS count. Therefore, the total number of patients affected by the iGAS outbreak is 34 and 13 of those patients have sadly died.

 

Update -  27 June 2019

Mid Essex streptococcus outbreak – statement by Dr Anna Davey, CCG Chair, at Board today

At the CCG's Board meeting in public held at Spring Lodge Community Centre in Witham this afternoon (Thursday 27 June), our Chair, Dr Anna Davey, gave the following update on the invasive Group A Streptococcus (iGAS) outbreak in mid Essex.

I want to give you all an update on the ongoing incident here in mid Essex. Twelve people have sadly died and I want to start by expressing our sincere condolences to their families.

We have established an incident management team and are working hard with colleagues from Public Health England, Provide Community Interest Company, who provide the majority of our out of hospital services, NHS England and NHS Improvement, to understand why this has happened and to prevent any more cases from occurring.

There have been 32 cases of iGAS in Essex. Those affected are elderly people in Braintree District, Chelmsford City and Maldon District. The vast majority of patients were receiving treatment for wounds, some in care homes but most in their own homes. A single case was found in Basildon in 2018 and a single case in Southend in February 2019. There does not appear to be a direct link between the cases in south Essex and mid Essex.

To give you a brief overview, Group A streptococcus, or GAS bacteria, can be found in the throat and on the skin and will not cause any illness for most people. Most Group A streptococcus infections can cause mild illnesses such as a sore throat, also known as strep throat, scarlet fever or a skin infection. For most healthy people this will cause no more than a mild illness.

On rare occasions, this bacteria can enter the body and cause severe, and sometimes life-threatening conditions. This is called Invasive Group A Streptococcal disease – iGAS. While this infection is rare, it is not new and has been seen in the UK before.

We have put in place measures to prevent the spread of this infection, including giving all community nursing staff who treat patients with chronic wounds antibiotic prophylaxis.

A deep cleaning of all community nurse bases has been conducted on all premises and to ensure the infection does not spread out of the locality, district nurse teams working within the CM7 Braintree area are only working within this postcode for the time being. This is because the majority of cases have been within this area.

We are taking wound swabs from all patients who are being treated for wounds in the area to check for the bacteria, and increasing opportunities for hand hygiene and use of personal protective equipment among staff.

We understand this is a worrying time for people, and know how frustrating it is that we don’t have answers to lots of the questions you may have. But we want to reassure members of the public that the risk of contracting iGAS is very low for most people. Treatment with antibiotics is very effective if started early.

We are continuing to work with Public Health England to stop the spread of this outbreak and ensure our local community is protected.

Our Freephone helpline number, 03000 032124, is open Monday to Friday, 9am to 5pm, for anyone with concerns about iGAS infection. We will also continue to keep our website updated as and when we have more information on the outbreak or investigation.

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