Group A Streptococcal Invasive Disease in England and Wales

During the last few years many countries have reported increases in invasive group A streptococcal (GAS) disease, particularly amongst previously healthy individuals as well as those with predisposing conditions such as immunosuppression, myelomas and varicella zoster infections5, 7, 9. The greatest change in the epidemiology of GAS disease over the years has been an expansion in the population at risk which now includes young, previously healthy adults and children as well as infants, young children, the elderly and immunocompromised individuals. In many cases severe GAS disease is associated with a specific focus such as empyema, septic arthritis, necrotising fasciitis or osteomyelitis where bacteraemia is usually documented. In 1994, much interest was stimulated by the cluster of necrotising fasciitis cases in one region of England1, 2 and, it was this incident that has led us to reassess our surveillance strategies for these diseases.