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Group A streptococcal infections during the seasonal influenza outbreak 2010/11 in South East England

On 10 January 2011, the United Kingdom (UK) Chief Medical Officer issued a statement advising primary and secondary care doctors to remain vigilant to the possibility of severe bacterial co-infection in patients with influenza [1], because preliminary data indicated an increase in bacterial diseases known to cause co-infection with influenza.

Streptococcus pyogenes, a Lancefield group A streptococcus, is known to be one of the major pathogens causing severe systemic disease during seasonal and pandemic influenza outbreaks. Invasive group A streptococcal (iGAS) disease is notifiable in the UK, and the infection has become a public health issue since the resurgence of invasive disease in the late 1980s [2].

Because iGAS has an increased incidence in winter months, it has been suggested that this may be related to seasonal influenza [2]. As reported by the World Health Organization (WHO) on 14 January 2011 [3], the current seasonal influenza outbreak has resulted in increased consultation rates across northern and western Europe. The WHO sentinel practices reported that 44% of swabs were positive for influenza. Of these, 74% were influenza A and 26% influenza B.

Since the start of the influenza season, we have noted a marked increase in iGAS disease in the Thames Valley area (Oxfordshire, Buckinghamshire and Berkshire) of South East England, with a catchment population of 2.2 million people (Figure). At the same time, a similar rise in iGAS incidence was noted across the whole of England as described by Zakikhany et al. in this issue of Eurosurveillance [4].

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