A community outbreak of invasive and non-invasive group A beta-haemolytic streptococcal disease in a town in South Wales

Abstract

An increase in the incidence of invasive and non-invasive infections caused by group A β-haemolytic streptococci (GAS) was noted in and around the town of Glynneath (population approx. 4000) in West Glamorgan, South Wales between 1 January and 30 June 1995. A total of 133 cases was ascertained with 127 (96%) occurring between 1 March and 30 June 1995. Six patients had invasive disease (one died) and all presented at the peak of the outbreak. There were 127 non-invasive cases of whom 7 were hospitalized. The outbreak was investigated to determine its extent and whether it was caused by a single M-serotype of GAS. Serotyping showed that 13 different M-serotypes were involved with the M1 serotype predominating. The overall incidence of GAS invasive disease in West Glamorgan (population 365000) increased sevenfold from a crude incidence of 0·5/105 per year in 1994 to 3·5/105 per year in 1995, but fell back to 0·75/105 per year in 1996. Eighty-two (80%) out of 102 individuals affected by GAS replied to a health questionnaire; sore throat was the commonest symptom reported (97%). Thirty-nine of these index cases identified at least one other member of their household who had experienced similar symptoms. The interval between the onset of illness in members of a single household was 0·83 days with a mean of 22 days. The mean duration of illness was 13·5 days and 61% of patients were treated with penicillin V for a mean duration of 9·3 days. Twenty-one per cent of GAS isolates were erythromycin-resistant and the M4 and M6 serotypes were especially resistant to erythromycin (87·5 and 100% resistance, respectively). Penicillin V failed to eradicate GAS from the throats of 25% of assessable patients. In this community, an outbreak of non-invasive disease caused by GAS was linked in time and place with an outbreak of serious invasive disease.