Stephanie Prior explains possible causes of fatal Strep A outbreak

In an article published by the Essex Chronicle, Stephanie Prior, Head of Medical Negligence, shares her view on what could be the cause behind the deadly Strep A outbreak that has claimed the lives of twelve people in Essex.

Group A Streptococcus (GAS) is a collection of bacteria that are known to cause a wide range of diseases. From mild fever to life-threatening illness the GAS are well known in the general public as the ‘flesh eating’ bugs, causing a condition called Necrotizing Fasciitis. The bacteria are also responsible for the headlining Toxic Shock Syndrome, which became associated with the use of highly absorbent tampons. However, this week, GAS is creating headlines for a new reason: an outbreak of GAS infection in Essex has claimed the lives of twelve people.

What is GAS infection?

GAS can be carried in the throat and on the skin of healthy people, without causing illness. Some people who become infected with GAS, experiences easily treatable illnesses such as a sore throat or skin infection. However, in vulnerable people, the GAS can cross into the bloodstream, giving rise to life-threatening illness known as Invasive Group A Streptococcus (iGAS).
Any area of the body can be affected by iGAS, including the lungs causing pneumonia and the lining of the brain causing meningitis. People vulnerable to these iGAS life-threatening illnesses include the elderly with open wounds.

32 cases and 12 deaths

According to the NHS Mid Essex Clinical Commissioning Group (CCG), to date there have been 32 confirmed cases of iGAS in the area, starting in Braintree District, and spreading to Chelmsford and Maldon. Many of those people affected are from the CN7 Braintree region. Of the 32 recorded cases, 12 have died, the first death occurring in February of this year. Those who died were elderly and receiving wound care in the community and in care homes.

How did this happen?

We know that GAS infection is spread through direct contact and through droplets cast into the air by coughs and sneezes. Given that the patients who died were receiving wound care, it is likely that their wounds were the sites of access for the iGAS. It also may be the case that the bacteria were spread from patient to patient by nurses providing wound care, but without paying adequate attention to appropriate infection control measures.

Certainly, this route of infection spread is acknowledged indirectly by the measures put in place by the NHS Mid Essex CCG, outlined below, which include deep cleaning of community nurse bases and tightening of infection control procedures. The current investigation into the outbreak should provide more definitive answers.

NHS Investigation and Infection Control

The NHS Mid Essex CCG held a public Board meeting on Thursday 27th June, during which the chair Dr Anna Davey, provided an update on the current iGAS outbreak. Dr Davey outlined the measures that have been taken by the Incident Management Team, in consultation with Public Health England, NHS England and NHS Improvement, the purpose to investigate why this fatal outbreak has happened and how to prevent more people from being infected.

These measures include:

• Tightening infection control, including providing antibiotic prophylaxis to staff who treat chronic wounds
• Deep cleansing of all community nurse bases
• Taking swabs from all patients being treated for wounds
• Providing a Freephone Helpline, open Monday to Friday 9am-5pm to advise those who are concerned about the outbreak: the number is 03000 032124.

In the meantime, the Incident Management Team continues to liaise with Essex care providers in hospitals and in the community.

MPs respond to public concern

MPs for mid Essex were informed of the GAS outbreak a few weeks ago.

Two of the people who died from iGAS were from the Witham constituency. Priti Patel is the MP for the area. She said, ‘I am naturally concerned about this outbreak, particularly as two out of the three people affected in Witham constituency have since passed away. I am working closely with the Mid Essex CCG, who are providing me with regular updates on the work the NHS is doing to manage and control the situation. I will continue to monitor the situation’.

MP for Braintree, James Cleverly said to the Braintree and Witham Times, ‘The CCG have highlighted what they are doing to make sure the bacteria is controlled. They are acting very professionally and doing everything they can to ensure that it doesn’t spread. I can absolutely understand why people are concerned […] but people who are healthy shouldn’t be worried. […] Anyone who is concerned should seek proper advice from a medical professional or from the NHS’.

Maldon MP John Whittingdale said, ‘I was obviously very concerned to learn that there have been a number of cases […] resulting in a number of deaths. There have been two cases in my own constituency. I welcome the rapid establishment of an Incident Management Team […] and the measures that are being put in place to identify the causes and to prevent any further infection’.
The last word goes to Rachel Hearn from the Mid Essex CCG who 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’.

The outbreak is believed to have started in Braintree before spreading to the Chelmsford and Maldon areas.

What to do if you’ve been affected?

Stephanie believes that affected families might have a case for suing service providers, depending on the outcome of the investigation. Families are advised to first lodge a complaint with the service provider before arranging a meeting to discuss complaints. If people are still unhappy after that, then that is the point to see a solicitor.