Group A streptococcal infections
Scarlet fever is a common childhood infection caused by Streptococcus pyogenes (also known as group A Streptococcus [GAS]). These bacteria may be found on the skin, throat, and other sites where they can live without causing problems. Under some circumstances GAS can cause non-invasive infections such as tonsillitis and scarlet fever. Invasive GAS (iGAS) is another infection caused by GAS, that is much rarer than scarlet fever.
Notifications (it is a notifiable disease) and GP consultations of scarlet fever in England have identified exceptional levels of activity during this early phase of the season. Notifications of invasive group A streptococcus (iGAS) disease remain at the top end of the range expected for this time of year.
Following higher than expected scarlet fever activity during the early part of this summer in England, notifications during the early part of the current 2022 to 2023 season – seasons extend from week 37 (mid-September) of one year to week 36 (mid-September) of the following year – increased to exceptional levels.
Updated UK public health guidance on the management of close contacts of iGAS cases in community settings was published on 15 December 2022, with additional close contact groups now recommended for antibiotic prophylaxis.
Interim clinical guidance on management of GAS infection was issued in December 2022 to optimise diagnosis and treatment during this current increase in infection. Following recent decreases in GAS activity, this guidance was rescinded in January.
Table 13. Number and rate per 100,000 population of scarlet fever and iGAS notifications in England: week 37 to week 4 of the 2022 to 2023 season
Week 37 to week 4 covers the period 12 September 2022 to 29 January 2023.
| Region | No of cases of scarlet fever | Rate of scarlet fever | Number of cases of iGAS | Rate of iGAS |
|---|---|---|---|---|
| England | 41,007 | 72.5 | 1,898 | 3.4 |
| North East | 1,679 | 64.1 | 109 | 4.1 |
Laboratory notifications of iGAS infection so far this season (weeks 37 to 4, 2022 to 2023) showed levels considerably higher than expected. A total of 1,898 notifications of iGAS disease were reported through laboratory surveillance in England, with a weekly high of 226 notifications in week 52 (26 December 2022 to 1 January 2023). This is considerably higher than the last high season (2017 to 2018) where activity peaked at 113 cases in week 14 (2 April 2018 to 8 April 2018. Laboratory notifications of iGAS infection this season are substantially higher than recorded over the last 5 seasons for the same weeks.
Table 14: Other selected organisms
| Hepatitis A | Hepatitis B | Hepatitis C | Legionella | Listeria | TB | |||
|---|---|---|---|---|---|---|---|---|
| North east | Q1 | Count | 0 | 42 | 200 | 0 | * | 12 |
| Rate | 0 | 6.3 | 29.8 | 0 | 0.3 | 1.8 | ||
| Q2 | Count | 0 | 46 | 227 | 0 | 0 | 19 | |
| Rate | 0 | 6.9 | 33.9 | 0 | 0 | 2.8 | ||
| Q3 | Count | * | 46 | 234 | 5 | * | 13 | |
| Rate | 0.4 | 6.9 | 34.9 | 0.7 | 0.6 | 1.9 | ||
| North Tyneside | Q1 | Count | 0 | * | 14 | 0 | 0 | 0 |
| Rate | 0 | 5.7 | 26.8 | 0 | 0 | 0 | ||
| Q2 | Count | 0 | * | 9 | 0 | 0 | 0 | |
| Rate | 0 | 3.8 | 17.2 | 0 | 0 | 0 | ||
| Q3 | Count | 0 | 0 | 10 | 0 | * | * | |
| Rate | 0 | 0 | 19.2 | 0 | 3.8 | 1.9 |
There were 234 reports of Hepatitis C in the Northeast in Q3 2022, giving a rate non- significantly higher than in Q3 2021 (34.9 vs. 29.7 per 100,000; 199 cases) but significantly lower than in Q3 2019 (53.6 per 100,000; 359 cases).
Table 15: Foodborne and waterborne infectious disease notifications 2022 (per quarter)
| Salmonella | E coli | Campy lobacter | Cryptos poridium | giardia | Shigella | |||
|---|---|---|---|---|---|---|---|---|
| North east | Q1 | Count | 47 | * | 704 | 23 | 16 | * |
| Rate | 7.0 | 0.4 | 105.0 | 3.4 | 2.4 | 0.7 | ||
| Q2 | Count | 81 | 11 | 910 | 43 | 19 | 6 | |
| Rate | 12.1 | 1.6 | 135.8 | 6.4 | 2.8 | 0.9 | ||
| Q3 | Count | 151 | 47 | 1068 | 77 | 20 | 6 | |
| Rate | 22.5 | 7.0 | 159.4 | 11.5 | 3.0 | 0.9 | ||
| North Tyneside | Q1 | Count | * | 0 | 48 | 0 | 0 | 0 |
| Rate | 1.9 | 0 | 91.9 | 0 | 0 | 0 | ||
| Q2 | Count | 5 | 0 | 80 | * | * | 0 | |
| Rate | 9.6 | 0 | 153.2 | 5.7 | 3.8 | 0 | ||
| Q3 | Count | 10 | 5 | 80 | 7 | * | 0 | |
| Rate | 19.2 | 6.2 | 153.2 | 13.4 | 3.8 | 0 |
Rate per 100,000 population estimates (ONS) *data suppressed due to small numbers.
- North Tyneside has higher rates for E. coli O157, campylobacter and cryptosporidium when compared to England, however these rates are similar to the Northeast.
- 1,068 cases of Campylobacter (159.4 per 100,000) were reported in the Northeast in Q3 2022. This rate was significantly higher than the rate reported in Q3 2021 (144.1 per 100,000; 966 cases) but was similar to the rate reported in Q3 2019 (160.6 per 100,000; 1076 cases).
- Rates from North Tyneside (153.2 per 100,000; 80 cases) did not differ significantly from Q3 2021 rates or the regional rate this quarter.