title: Ongoing outbreak of invasive and non-invasive disease due to group A Streptococcus (GAS) type emm66 among homeless and people who inject drugs in England and Wales, January to December 2016.
abstract: We report an outbreak of invasive and non-invasive disease due to an unusual type of Streptococcus pyogenes (group A Streptococcus, emm66) among a vulnerable, largely homeless population in southern England and Wales, detected in September 2016. Twenty-seven confirmed cases were subsequently identified between 5 January and 29 December 2016; 20 injected drugs and six reported problematic alcohol use. To date, we have ruled out drug-related vehicles of infection and identified few common risk factors.
authors.affiliation: United Kingdom Field Epidemiology Training Programme, Public Health England, United Kingdom.|Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: Nick
authors.initials: N
authors.lastname: Bundle
authors.affiliation: Reference Department Microbiology Services Division, National Infection Service, Public Health England, London, United Kingdom.|European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: Laura
authors.initials: L
authors.lastname: Bubba
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Juliana
authors.initials: J
authors.lastname: Coelho
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.|United Kingdom Public Health Specialty Training Programme.|Public Health England South West, Bristol, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kwiatkowska
authors.affiliation: Public Health England South East, Horsham, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cloke
authors.affiliation: Public Health England South West, Bristol, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: King
authors.affiliation: Public Health England South East, Horsham, United Kingdom.
authors.forename: Jill
authors.initials: J
authors.lastname: Rajan-Iyer
authors.affiliation: Public Health England South East, Horsham, United Kingdom.
authors.forename: Max
authors.initials: M
authors.lastname: Courtney-Pillinger
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Beck
authors.affiliation: Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.|HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Vivian
authors.initials: V
authors.lastname: Hope
authors.affiliation: Healthcare-Associated Infection & Antimicrobial Resistance Department, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Theresa
authors.initials: T
authors.lastname: Lamagni
authors.affiliation: Respiratory and Vaccine Preventable Bacteria Reference Unit, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Colin S
authors.initials: CS
authors.lastname: Brown
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: Daiga
authors.initials: D
authors.lastname: Jermacane
authors.affiliation: HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Glass
authors.affiliation: HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom.
authors.forename: Monica
authors.initials: M
authors.lastname: Desai
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.
authors.forename: Maya
authors.initials: M
authors.lastname: Gobin
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.
authors.forename: Sooria
authors.initials: S
authors.lastname: Balasegaram
authors.affiliation: Field Epidemiology Services, National Infection Service, Public Health England, London and Bristol, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Anderson
mesh_terms: D000328:Adult; D017677:Age Distribution; D018563:Disease Notification; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D035862:Vulnerable Populations; D014852:Wales / Q000453:epidemiology
keywords: epidemiology; invasive streptococcal infections; outbreak, homelessness, Emm66; people who inject drugs