Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP
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 softwar...
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BMJ Publishing Group
2024-08-01
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| Series: | BMJ Medicine |
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| author | 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 Christine Cunningham Victoria Speed Ben FC Butler-Cole Sebastian CJ Bacon Thomas O'Dwyer Liam C Hart |
| author_facet | 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 Christine Cunningham Victoria Speed Ben FC Butler-Cole Sebastian CJ Bacon Thomas O'Dwyer Liam C Hart |
| author_sort | Ben Goldacre |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-76a3f50c7f87442e84bd0cb88b74f1ba |
| institution | DOAJ |
| issn | 2754-0413 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Medicine |
| spelling | doaj-art-76a3f50c7f87442e84bd0cb88b74f1ba2025-08-20T02:51:11ZengBMJ Publishing GroupBMJ Medicine2754-04132024-08-013110.1136/bmjmed-2023-000791Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPPBen Goldacre0David Evans1Sam Harper2Richard Croker3Christopher Wood4Brian MacKenna5Elizabeth Beech6Chris Bates7Amir Mehrkar8Peter Inglesby9Jonathan Cockburn10John Parry11Frank Hester12Kieran Hand13Helen Curtis14Rose Higgins15Andrew D Brown16Simon Davy17George Hickman18Tom Ward19Rebecca M Smith20Louis Fisher21Iain Dillingham22Steven Maude23Lucy Bridges24Christine Cunningham25Victoria Speed26Ben FC Butler-Cole27Sebastian CJ Bacon28Thomas O'Dwyer29Liam C Hart30directorThe DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKTPP, Leeds, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNHS England, London, UKTPP, Leeds, UK11 Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKTPP, Leeds, UKTPP, Leeds, UKTPP, Leeds, UKNHS England, London, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKUniversity of Arkansas for Medical Sciences, Little Rock, Arkansas, USABennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKBennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKObjective 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.https://bmjmedicine.bmj.com/content/3/1/e000791.full |
| spellingShingle | 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 Christine Cunningham Victoria Speed Ben FC Butler-Cole Sebastian CJ Bacon Thomas O'Dwyer Liam C Hart Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP BMJ Medicine |
| title | Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP |
| title_full | Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP |
| title_fullStr | Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP |
| title_full_unstemmed | Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP |
| title_short | Incidence and treatment of group A streptococcal infections during covid-19 pandemic and 2022 outbreak: retrospective cohort study in England using OpenSAFELY-TPP |
| title_sort | incidence and treatment of group a streptococcal infections during covid 19 pandemic and 2022 outbreak retrospective cohort study in england using opensafely tpp |
| url | https://bmjmedicine.bmj.com/content/3/1/e000791.full |
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