Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP
Ben Goldacre,
David Evans,
Sam Harper,
Richard Croker,
Christopher Wood,
Brian MacKenna,
Elizabeth Beech,
Chris Bates,
Amir Mehrkar,
Peter Inglesby,
Jonathan Cockburn,
John Parry,
Frank Hester,
Kieran Hand,
Helen Curtis,
Rose Higgins,
Andrew D Brown,
Simon Davy,
George Hickman,
Tom Ward,
Rebecca M Smith,
Louis Fisher,
Iain Dillingham,
Steven Maude,
Lucy Bridges,
Linda Gough,
Christine Cunningham,
Victoria Speed,
Ben FC Butler-Cole,
Sebastian CJ Bacon,
Thomas O'Dwyer,
Liam C Hart
Affiliations
Ben Goldacre
director EBM DataLab
David Evans
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Sam Harper
TPP, Leeds, UK
Richard Croker
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Christopher Wood
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Brian MacKenna
NHS England, London, UK
Elizabeth Beech
3 NHS England, Taunton, UK
Chris Bates
TPP, Leeds, UK
Amir Mehrkar
1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Unviersity of Oxford, Oxford, UK
Peter Inglesby
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jonathan Cockburn
TPP, Leeds, UK
John Parry
TPP, Leeds, UK
Frank Hester
TPP, Leeds, UK
Kieran Hand
NHS England, London, UK
Helen Curtis
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Rose Higgins
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Andrew D Brown
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Simon Davy
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
George Hickman
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Tom Ward
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Rebecca M Smith
Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
Louis Fisher
Bennett Institute for Applied Data Science, University of Oxford, Oxford, UK
Iain Dillingham
1 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, Unviersity of Oxford, Oxford, UK
Steven Maude
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Lucy Bridges
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Linda Gough
Christine Cunningham
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Victoria Speed
King`s Thrombosis Centre, Department of Haematological Medicine, King`s College Hospital NHS Foundation Trust, London, UK
Ben FC Butler-Cole
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Sebastian CJ Bacon
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Thomas O'Dwyer
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Liam C Hart
Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Objective To investigate the effect of the covid-19 pandemic on the number of patients with group A streptococcal infections and related antibiotic prescriptions.Design Retrospective cohort study in England using OpenSAFELY-TPP.Setting Primary care practices in England that used TPP SystmOne software, 1 January 2018 to 31 March 2023, with the approval of NHS England.Participants Patients registered at a TPP practice at the start of each month of the study period. Patients with missing data for 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 Monthly counts and crude rates of patients with group A streptococcal infections (sore throat or tonsillitis, scarlet fever, and invasive group A streptococcal infections), and recommended firstline, alternative, and reserved antibiotic prescriptions linked with a group A streptococcal infection before (pre-April 2020), during, and after (post-April 2021) covid-19 restrictions. Maximum and minimum count and rate for each infectious season (time from September to August), as well as the rate ratio of the 2022-23 season compared with the last comparably high season (2017-18).Results The number of patients with group A streptococcal infections, and antibiotic prescriptions linked to an indication of group A streptococcal infection, peaked in December 2022, higher than the peak in 2017-18. The rate ratios for monthly sore throat or tonsillitis (possible group A streptococcal throat infection), scarlet fever, and invasive group A streptococcal infection in 2022-23 relative to 2017-18 were 1.39 (95% confidence interval (CI) 1.38 to 1.40), 2.68 (2.59 to 2.77), and 4.37 (2.94 to 6.48), respectively. The rate ratio for prescriptions of first line, alternative, and reserved antibiotics to patients with group A streptococcal infections in 2022-23 relative to 2017-18 were 1.37 (95% CI 1.35 to 1.38), 2.30 (2.26 to 2.34), and 2.42 (2.24 to 2.61), respectively. For individual antibiotic prescriptions in 2022-23, azithromycin showed the greatest relative increase versus 2017-18, with a rate ratio of 7.37 (6.22 to 8.74). This finding followed a marked decrease in the recording of patients with group A streptococcal infections and associated prescriptions during the period of covid-19 restrictions where the maximum count and rates were lower than any minimum rates before the covid-19 pandemic.Conclusions Recording of rates of scarlet fever, sore throat or tonsillitis, and invasive group A streptococcal infections, 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 analysis of clinical and demographic subgroups.
