Open sidebar
Reports

Group A streptococcal cases and treatments during the COVID-19 pandemic: a rapid report

Description
This rapid report describes monthly changes in the recording of diagnoses and symptoms related to group A streptococcal infection and the prescribing of antibiotics used to treat group A streptococcal infection. The supporting weekly report can be found here https://reports.opensafely.org/reports/scarlet-fever-and-invasive-group-a-strep-cases-throughout-the-covid-19-pandemic-weekly/. A full description of the methods and results can be found in the preprint https://www.medrxiv.org/content/10.1101/2023.09.22.23295850v1.
Authors
Christine Cunningham, Louis Fisher, Christopher Wood, The OpenSAFELY Collaborative, Victoria Speed, Andrew D Brown, Helen J Curtis, Rose Higgins, Richard Croker, Ben FC Butler-Cole, David Evans, Peter Inglesby, Iain Dillingham, Sebastian CJ Bacon, Elizabeth Beech, Kieran Hand, Simon Davy, Tom Ward, George Hickman, Lucy Bridges, Thomas O’Dwyer, Steven Maude, Rebecca M Smith, Amir Mehrkar, Liam C Hart, Chris Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Ben Goldacre, Brian MacKenna
Contact
Get in touch and tell us how you use this report or new features you'd like to see: team@opensafely.org
First published
25 Jan 2023
Last released
19 Apr 2023
Links

Group A streptococcal cases and treatments during the COVID-19 pandemic: a rapid report

01-01-2018 through 31-03-2023 by month

Background

During the COVID-19 pandemic there has been a substantial change to the pattern of circulating viruses and bacteria that cause illnesses. In order to support ongoing response and recovery of NHS services from the COVID-19 pandemic, it is useful to have detailed information on patterns of disease being reported by the NHS and on treatments such as antibiotics.

In the winter of 22/23 UKHSA (December 8th) reported an unseasonal increase of scarlet fever and group A streptococcus infections. Sadly, between 19th September 2022 and 26th March 2023 there have been 355 deaths in England across all age groups, including 40 children under 18. UKHSA indicates that the increase is likely to reflect increased susceptibility to these infections in children due to low numbers of cases during the COVID-19 pandemic, along with current circulation of respiratory viruses. As of March 26th 2023, scarlet fever notifications have returned to expected levels, but invasive group A strep notifications remain higher than normal.

This rapid report describes changes in the recording of diagnoses and symptoms related to group A streptococcal infection and the prescribing of antibiotics used to treat group A streptococcal infection. We will routinely update the data in this report and invite anyone who finds it useful to get in touch and tell us how you use this report or new features you'd like to see.

Methods

This study used data from OpenSAFELY-TPP, which covers 40% of the population of England. For a description of the representativeness of this sample, please see our manuscript here. Individuals were included if they were alive and registered at a TPP practice each month, across the study period. Patients were excluded if their listed age was not between 0 and 120 years.

Counts represent patients with at least one prescription or clinical event in that month. Patients with more than one of the same prescription or clinical event in a month were only counted once. Rates divide the count by the included study population and multiply by 1,000 to achieve a rate per 1,000 registered patients.

Counts <=5 have been redacted and all numbers rounded to the nearest 10 to avoid potential re-identification of individuals. The rates displayed were computed with these rounded counts.

Prescribing data is based on prescriptions issued within the Electronic Health Record. Prescriptions may not always be dispensed or in some cases the dispensed item may differ from the prescribed item due to the use of a Serious Shortage Protocol.

Clinical events data is based on a clinical code being added to a patient's record. This is often added by a clinician during a consultation to indicate the presence of a sign/symptom (e.g. sore throat) or that a clinical diagnosis has been made (e.g. Scarlet Fever). These codes do not necessarily indicate positive test results.

Links to the codelist for each analysis can be found beneath the relevant section.

Antibiotic Prescribing

The below charts show the count and rate of patients prescribed the following antibiotics each month: phenoxymethylpenicillin, amoxicillin, clarithromycin, erythromycin, azithromycin, flucloxacillin, cefalexin and co-amoxiclav. This is based on the antibiotic recommendation given in NHS England Group A streptococcus in children: Interim clinical guidance summary 22nd December 2022.

Any antibiotic

Counts: represent patients with at least one prescription event in that month. Patients with more than one of the same prescription in a month were only counted once. Counts <=5 were redacted and all numbers were rounded to the nearest 10.
Rates: divide the count by the included study population and multiply by 1,000 to achieve a rate per 1,000 registered patients.
Note: Prescribing data is based on prescriptions issued within the Electronic Health Record. Prescriptions may not always be dispensed or in some cases the dispensed item may differ from the prescribed item due to the use of a Serious Shortage Protocol

The below charts show the count of patients prescribed any of the above listed antibiotics each month, followed by a table with the underlying counts and a chart with of the rate of prescribing with the years stacked on top of each other.

Date Patient Count Amoxicillin Azithromycin Cefalexin Clarithromycin Co Amoxiclav Erythromycin Flucloxacillin Phenoxymethylpenicillin
01-01-18 23816470 416960 19640 22480 100210 49550 34170 114030 83330
01-02-18 23864720 300380 18180 19390 75850 41160 29350 103560 80640
01-03-18 23900720 280150 18790 20280 75070 42680 30210 113600 91710
01-04-18 23930720 222280 17960 19600 65180 39560 26280 116640 73930
01-05-18 23973370 207280 18100 19760 63360 39520 26420 130090 73160
01-06-18 24004950 172180 17090 19090 57550 37960 23710 138260 63280
01-07-18 24028930 163050 17500 19480 58640 39180 23700 157020 59880
01-08-18 24069930 149250 17550 19910 54480 39620 21260 143940 47070
01-09-18 24103990 186510 17400 18670 55320 36760 20670 118510 46970
01-10-18 24138420 258180 19930 20600 68020 42050 24850 125970 58770
01-11-18 24193720 271100 19810 19870 67060 39460 24700 114280 61830
01-12-18 24223360 308020 19680 19640 71880 38660 23940 99450 64690
01-01-19 24239080 353770 20550 20910 85390 42970 25640 111760 74340
01-02-19 24282590 282780 19080 18580 71530 37220 23090 102010 69230
01-03-19 24304780 243360 19440 19500 66660 38070 22780 111500 72420
01-04-19 24326150 228950 19250 19300 64150 36780 21790 110860 66140
01-05-19 24354350 191700 19130 19540 60190 36970 20630 118040 62050
01-06-19 24378970 165500 17580 18480 53700 34040 18520 116740 57390
01-07-19 24409790 172840 19010 20540 61320 38420 21390 156740 64550
01-08-19 24447460 145420 18360 19890 53540 36020 18200 139230 48460
01-09-19 24474940 183170 19270 20080 56310 36160 18710 125550 53510
01-10-19 24508740 256750 20820 20900 68210 39260 21440 121160 64220
01-11-19 24567720 273550 20700 19960 68330 37000 21460 108670 68610
01-12-19 24600400 357470 21650 20770 80460 39440 24050 102850 79380
01-01-20 24613110 312320 21620 21680 81390 41320 22280 114250 77790
01-02-20 24653160 241590 20350 19420 66060 35400 20000 102790 76330
01-03-20 24680540 266050 24410 22400 74980 42100 22240 110640 85420
01-04-20 24700320 151040 20980 21700 54020 40870 15750 109330 48000
01-05-20 24691700 96550 19460 20040 41110 34990 13490 111480 36960
01-06-20 24692400 93450 19750 21250 41550 36340 14120 129730 37680
01-07-20 24699260 92820 19660 21980 42060 36630 14480 131480 39720
01-08-20 24716720 86770 18540 19810 38640 32270 13290 126550 35840
01-09-20 24726330 141780 20840 22700 48720 36810 15990 129020 54720
01-10-20 24742820 135860 20770 22870 46090 36680 14930 114630 43760
01-11-20 24775380 125070 21260 22790 44200 36610 14410 111050 43390
01-12-20 24799370 133120 21510 23370 45100 37440 14370 109180 45400
01-01-21 24814170 123690 20580 21860 42040 35240 13320 100780 38800
01-02-21 24834870 102390 19520 21200 38020 32760 12710 102430 36100
01-03-21 24861590 121780 20830 23980 44550 36200 14810 124900 45770
01-04-21 24911500 116910 19280 21440 40520 32030 13760 110080 41010
01-05-21 24945240 138980 18580 20800 41940 31520 14760 101610 49240
01-06-21 24979400 167280 19450 22450 49330 35450 16730 129950 52670
01-07-21 25017380 163120 19000 22670 50280 36120 16270 138770 52670
01-08-21 25052200 147590 18930 22990 46870 34960 14420 123260 48840
01-09-21 25077030 210110 19980 23920 56760 37050 16770 126360 66940
01-10-21 25109010 277710 20160 23790 63310 37460 18210 110850 70510
01-11-21 25150630 286220 21140 24760 67540 38750 18680 111900 76910
01-12-21 25189030 284560 21410 24790 66690 39220 18100 104750 79400
01-01-22 25212560 196200 20860 23910 54180 35510 14550 102790 66420
01-02-22 25243710 178260 19740 22510 50380 33480 14400 100980 67480
01-03-22 25260560 233630 21020 25050 62730 38940 17250 118120 85300
01-04-22 25276230 201470 19540 22600 54420 34200 14770 102130 70030
01-05-22 25289780 196170 20050 24050 56920 36840 15750 119490 81150
01-06-22 25316240 186530 19180 23100 55580 34620 15390 119080 80410
01-07-22 25335660 184360 19190 23270 57320 35270 15760 132390 85340
01-08-22 25351060 151750 19570 25400 52980 36700 13950 138380 66420
01-09-22 25382020 183320 20310 25390 53420 36060 13720 119860 67980
01-10-22 25405980 268030 20740 25650 64910 37240 16200 111150 82690
01-11-22 25458380 320560 21450 26600 73880 38960 19190 113140 103660
01-12-22 25494320 558480 26390 31650 124680 47980 43250 104600 193910
01-01-23 25500600 346410 22660 28240 82650 43480 20600 111800 116470
01-02-23 25529380 279330 20730 25220 68960 38570 16920 106060 107730
01-03-23 25541940 289660 22270 27800 74550 43040 18990 121050 119540

The below charts show the monthly count and rate of patients with any of the listed antibiotics across the study period, with a breakdown by key demographic subgroups.

Count
Rate