Precautions taken to protect nurses in deadly Strep A outbreak

More than 30 people in the mid Essex districts of Braintree, Chelmsford and Maldon – most of whom were receiving nursing care for chronic wounds – have contracted the invasive Group A streptococcus (IGAS) infection, it has been confirmed.

“Extra infection control measures have been put in place to prevent the infection spreading”

Rachel Hearn

Hundreds of patients receiving wound care have been tested and all district nursing staff in mid Essex have been given precautionary antibiotics as part of efforts to contain the outbreak.

Mid Essex Clinical Commissioning Group, which is leading the NHS response, said there had been 32 confirmed cases of IGAS to date.

The average age of patients affected was 87 and the majority had been receiving care for chronic wounds either in their own homes or care homes, said the CCG.

An incident management team has been set up supported by NHS England and NHS Improvement.

This includes Public Health England and health and social care provider Provide Community Interest Company, which delivers a range of community services in the area including adult nursing.

Most Strep A infections cause relatively mild illnesses such as a sore throat – also known as “strep throat” – scarlet fever or skin infection.

But on rare occasions the bacteria can enter the body and cause severe and even life-threatening conditions. This kind of infection is referred to as IGAS disease.

The CCG said the strain of IGAS found in mid Essex had been seen in the UK before.

A CCG report revealed the outbreak was originally confined to the Braintree area but “unfortunately the cases have now spread to the Chelmsford and Maldon areas”.

There was a single case in Basildon in 2018 and another in Southend in February but “currently there appears to be no direct link” between these and the cases in mid Essex, said the report.

One precaution being taken is the “cohorting” of district nurse teams in a specific area of Braintree where the majority of cases have occurred.

This means just one team of nurses is taking care of patients in the CM7 area of Braintree and will not be working with any patients outside that zone, explained a CCG spokeswoman.

“This is still an evolving situation and colleagues are working very hard to contain it”

Jorg Hoffmann

The CCG said additional infection control measures had been put in place to prevent the infection spreading.

These included enhanced hand hygiene measures and increased use of “personal protective equipment” such as gloves.

All community nurse bases in the area had also been deep-cleaned, said the CCG.

Rachel Hearn, director of nursing and quality at Mid Essex CCG, said her thoughts were with the families of those patients who had died.

“The NHS in Essex is working closely with Public Health England and other partners to manage this local incident, and extra infection control measures have been put in place to prevent the infection spreading in the area,” she said.

“The risk of contracting IGAS is very low for the vast majority of people and treatment with antibiotics is very effective if started early. We will continue to work with our partners in Public Health England to investigate how this outbreak occurred and take every possible step to ensure our local community is protected.”

The CCG report confirmed partners had yet to establish the source of the outbreak or how it had spread.

“The cause of the spread of the infection has not yet been identified and a full investigation is being carried out to understand how it may have spread and any additional control measure required,” said the report.

“The incident management team have been keeping GPs, hospital and community providers in Essex and care homes informed to give them additional information on IGAS and details of who they should contact if they have concerns,” it added.

A freephone helpline has also been set up for anyone with concerns.

Dr Jorg Hoffmann, deputy director for health protection for Public Health England East of England, also stressed the risk of contracting IGAS was “very low for healthy people”.

“All those affected are in vulnerable groups, which puts them at higher risk for what is normally a rarer form of Group A Streptococcal infection,” he said.

“This is still an evolving situation and colleagues in the provider organisation, the CCG, NHS England, NHS Improvement and PHE are working very hard to contain it.”