Have reducing tonsillectomy rates in England led to increasing incidence of invasive Group A <i>Streptococcus</i> infections in children?

Banigo, Adonye; Moinie, Ahmad; Bleach, N. R.; Chand, Meera; Chalker, Victoria J.; Lamagni, Theresa

doi:10.1111/coa.13095

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…There are multiple hypotheses for this trend, including the difficulty in accessing primary care appointments and the increased pressure on primary care to rationalise antibiotic prescribing for sore throats 7 . There is also a downward trend in the number of tonsillectomies being performed in the UK because of stricter guidelines, which could be causing the epiphenomenon of an increase in cases of severe tonsillitis and its complications 1 , 8 Acute tonsillitis cases referred to ENT are rising, with a high volume being admitted overnightThis study supports evidence that patients can often be managed without overnight admission and introduces the concept of using an ambulatory medical unitThe ambulatory medical unit is a novel concept that may help in the management of rising acute tonsillitis casesThis is a safe and cost-efficient method of managing acute tonsillitis in secondary care…”

Section: Discussionmentioning

confidence: 58%

“…Patients who are unable to eat and drink are prescribed intravenous crystalloid fluids to manage dehydration, and a dose of intravenous antibiotics. Benzylpenicillin is given as a first-line treatment, as it is effective against the most common organism implicated in acute bacterial tonsillitis in adults, group A haemolytic streptococci 8 , 14 . It also avoids the potential risk of side effects when amoxicillin is given to patients with infectious mononucleosis.…”

Section: Discussionmentioning

confidence: 99%

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Implementing a guideline for acute tonsillitis using an ambulatory medical unit

et al. 2019

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ObjectiveAcute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.MethodsA retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.ResultsThe rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.ConclusionThe tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Implementing a guideline for acute tonsillitis using an ambulatory medical unit

et al. 2019

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“…The subsequent rise in incidence to 2016 should be interpreted with caution as the absolute number of cases is small (22 in 2013 to 27 in 2016) and the confidence intervals imply no statistically significant increase. However, the overall incidence of iGAS in England has increased in this period from 2.47 (2011) to 4.53 (2016) per 100 000 py . The incidence of severe postpartum GAS infection described is higher than in US studies (59 per 100 000 person‐years) because of our inclusion of severe GAS cases.…”

Section: Discussionmentioning

confidence: 71%

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Leonard

Wright

Saavedra-Campos

et al. 2018

BJOG

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Objective We describe cases of invasive group A Streptococcus (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28 days of birth and investigation of clusters in maternity units.Design Cross-sectional retrospective study. Setting and population Notified confirmed iGAS cases in either mothers or neonates with onset within 28 days of birth in London and the South East of England between 2010 and 2016Method Review of public health records of notified cases.Main outcome measures Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6 months.Results We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28 days postpartum was 109 (95% CI 90-127) compared with 1.3 in other females aged 15-44. For neonates the incidence was 1.5 (95% CI 9-23). The median onset time was 2 days postpartum [interquartile range (IQR) 0-5 days] for mothers and 12 days (IQR 7-15 days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued.Conclusions iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved.

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“…Of ≈10,000 iGAS cases identified during our study, only 11 were associated with scarlet fever contact: as such, a proportionate response to further investigations is warranted. Although increases in iGAS infection have been observed during the latter period of the scarlet fever upsurge (2016 onward), these increases follow a longer-term trend of increasing iGAS infection in England, and the connection with increased scarlet fever activity remains unclear ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Increased Risk for Invasive Group AStreptococcusDisease for Household Contacts of Scarlet Fever Cases, England, 2011–2016

Watts¹,

Balasegaram²,

Brown³

et al. 2019

Emerg. Infect. Dis.

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The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011–2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts > 75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

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Have reducing tonsillectomy rates in England led to increasing incidence of invasive Group A Streptococcus infections in children?

Cited by 11 publications

References 17 publications

Implementing a guideline for acute tonsillitis using an ambulatory medical unit

Implementing a guideline for acute tonsillitis using an ambulatory medical unit

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Increased Risk for Invasive Group AStreptococcusDisease for Household Contacts of Scarlet Fever Cases, England, 2011–2016

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