Paper information
- Authors
-
- Christine Cunningham,
- Louis Fisher,
- Chris Wood,
- Vicky Speed,
- Andrew Brown,
- Helen Curtis,
- Rose Higgins,
- Richard Croker,
- Ben Butler-Cole,
- Dave Evans,
- Peter Inglesby,
- Iain Dillingham,
- Seb Bacon,
- Elizabeth Beech,
- Kieran Hand,
- Simon Davy,
- Tom Ward,
- George Hickman,
- Lucy Bridges,
- Tom O'Dwyer,
- Steven Maude,
- Becky Smith,
- Amir Mehrkar,
- Liam Hart,
- Chris Bates,
- Jonathan Cockburn,
- John Parry,
- Frank Hester,
- Sam Harper,
- Ben Goldacre,
- Brian MacKenna
- Citation
- Cunningham C, Fisher L, Wood C, The OpenSAFELY Collaborative, et al. Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak: a retrospective cohort study in England using OpenSAFELY-TPP. medRxiv 2023.09.22.23295850; doi: https://doi.org/10.1101/2023.09.22.23295850
- Categories
Abstract
Objective
To investigate the impact of the COVID-19 pandemic on Group A streptococcal (GAS) cases and related antibiotic prescriptions.
Design
A retrospective cohort study with supporting dashboards with the approval of NHS England.
Setting
Primary care practices in England using TPP SystmOne software from January 2018 through March 2023.
Participants
Patients included were those registered at a TPP practice for each month of the study period. Patients with missing sex or age were excluded, resulting in a population of 23,816,470 in January 2018, increasing to 25,541,940 by March 2023.
Main outcome measures
We calculated monthly counts and crude rates of GAS cases (sore throat/tonsillitis, scarlet fever, invasive group A strep) and prescriptions linked with a GAS case, before (pre-April 2020), during and after (post-April 2021) COVID-19 restrictions. We calculated the maximum and minimum count and rate for each season (years running September-August), and the rate ratio (RR) of the 2022/23 season to the last comparably high season (2017/18).
Results
Recording of GAS cases and antibiotic prescription linked with a GAS case peaked in December 2022, higher than the 2017/2018 peak. The peak rate of monthly sore throat/tonsillitis (possible group A strep throat) recording was 5.33 per 1,000 (RR 2022/23 versus 2017/18 1.39 (CI: 1.38 to 1.40)). Scarlet fever recording peaked at 0.51 per 1,000 (RR 2.68 (CI: 2.59 to 2.77)), and invasive group A streptococcal infection (iGAS) at 0.01 per 1,000 (RR 4.37 (CI: 2.94 to 6.48)). First line antibiotics with a record of a GAS infection peaked at 2.80 per 1,000 (RR 1.37 (CI:1.35 to 1.38)), alternative antibiotics at 2.03 per 1,000 (RR 2.30 (CI:2.26 to 2.34)), and reserved antibiotics at 0.09 per 1,000 (RR 2.42 (CI:2.24 to 2.61)). For individual antibiotics, azithromycin with GAS indication showed the greatest relative increase (RR 7.37 (CI:6.22 to 8.74)).This followed a sharp drop in recording of cases and associated prescriptions during the period of COVID-19 restrictions where the maximum count and rates were lower than any pre COVID-19 minimum.
More detailed demographic breakdowns can be found in our regularly updated dashboard report.
Conclusions
Rates of scarlet fever, sore throat/tonsillitis and iGAS recording and associated antibiotic prescribing peaked in December 2022. Primary care data can supplement existing infectious disease surveillance through linkages with relevant prescribing data and detailed clinical and demographic subgroups.