In March 2024, the East Midlands Health Protection Team was notified of a case of invasive Group A Streptococcus (iGAS) infection in an elderly care home resident. Twenty-two days later, another case in a resident from the same floor of the care home was notified. In accordance with national guidelines, an outbreak was declared, and a multidisciplinary outbreak control team (OCT) was urgently convened. Screening for GAS throat carriage was undertaken for staff and residents, excluding those receiving end-of-life care. All isolates were strain typed and characterised. Infection prevention and control (IPC) visits were undertaken to provide ongoing support. Screening identified five residents and five staff members positive for GAS. Antibiotic prophylaxis was provided to all staff throughout the setting (n = 74) and all residents on the affected floor (n = 35). Three individuals were positive on repeat screening. All staff and residents screened negative after 4 months and the two clinical cases recovered. Eleven of the 12 GAS isolates were identified as emm 3.93. This outbreak highlighted the importance of rapid screening, possible only through the deployment of a dedicated team, and rescreening post-decolonising treatment, as a means to contain such outbreaks.

In 2022, an increase in invasive group A streptococcal (iGAS) infections was observed in the Netherlands. A particular increase was seen among children; therefore, we aimed to assess risk factors for iGAS infection in children aged 6 months to 5 years. A prospective case–control study was conducted between February and May 2023. We approached parents of notified iGAS cases to complete a questionnaire on exposures during 4 weeks prior to disease onset. Controls were recruited via social media and matched to cases on sex and birthyear. Conditional logistic regression was performed to estimate odds ratios (OR) of exposures. For the analysis, we included 18 cases and 103 controls. Varicella prior to onset of iGAS disease was reported in two (11%) cases and one (1%) control (OR: 12.0, 95% CI: 1.1–139.0). Exposure to group A streptococcal (GAS)-like illnesses such as impetigo, pharyngitis, and scarlet fever was reported in 8 (44%) cases and 15 (15%) controls (OR: 7.1, 95% CI: 1.8–29.0). Our findings are in line with previous studies by identifying varicella as a risk factor for iGAS among young children and highlight the association with non-invasive GAS infections in the community as a possible source of transmission.