Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak: a retrospective cohort study in England using OpenSAFELY-TPP
Group A streptococcal cases and treatments during the COVID-19 pandemic and 2022 outbreak: a retrospective cohort study in England using OpenSAFELY-TPP
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COVID-19 大流行和 2022 年爆发期间的 A 组链球菌病例和治疗：使用 OpenSAFELY-TPP 在英格兰进行的一项回顾性队列研究
DOI：
10.1101/2023.09.22.23295850
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Cunningham C
中科院分区：
文献类型：
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作者：
Cunningham C
目的探讨COVID-19大流行对A组链球菌（GAS）病例和相关抗生素处方的影响。设计一项回顾性队列研究，支持仪表板，并获得NHS England的批准。设置2018年1月至2023年3月期间使用TPP SystmOne软件的英格兰初级保健实践。患者包括研究期间每个月在TPP实践中注册的患者。排除了性别或年龄缺失的患者，2018年1月的人口为23，816，470人，到2023年3月增加到25，541，940人。主要结局指标我们计算了GAS病例的月计数和粗率（喉咙痛/扁桃体炎，猩红热，侵袭性A组链球菌）和与GAS病例相关的处方，（二零二零年四月前）、COVID-19限制期间及之后（二零二一年四月后）。我们计算了每个季节（9月至8月）的最大和最小计数和比率，以及2022/23季节与上一个高季节（2017/18）的比率（RR）。结果GAS病例和与GAS病例相关的抗生素处方的记录在2022年12月达到峰值，高于2017/2018年的峰值。记录的每月咽喉痛/扁桃体炎（可能为A组链球菌性咽喉炎）的峰值发生率为5.33/1000（RR 2022/23 vs 2017/18 1.39（CI：1.38 - 1.40））。猩红热记录峰值为0.51/1000（RR 2.68（CI：2.59至2.77）），侵袭性A组链球菌感染（iGAS）为0.01/1000（RR 4.37（CI：2.94至6.48））。有GAS感染记录的一线抗生素峰值为2.80/1000（RR 1.37（CI：1.35 - 1.38）），替代抗生素为2.03/1000（RR 2.30（CI：2.26 - 2.34）），保留抗生素为0.09/1000（RR 2.42（CI：2.24 - 2.61））。就个别抗生素而言，阿奇霉素与GAS适应症显示出最大的相对增幅（RR 7.37（CI：6.22至8.74））。在COVID-19限制期间，最大数量和比率低于COVID-19前的任何最低值，病例和相关处方记录急剧下降。更详细的人口统计分析可在我们定期更新的仪表板报告中找到。结论猩红热、咽喉痛/扁桃体炎和iGAS记录和相关抗生素处方的比率在2022年12月达到峰值。通过与相关处方数据以及详细的临床和人口统计学亚组的联系，基层医疗数据可以补充现有的传染病监测。已知情况在COVID-19大流行期间，导致疾病的病毒和细菌的传播模式发生了重大变化。从2022年12月开始，英格兰A组链球菌感染激增，截至2023年5月7日，426人死亡，其中包括48名儿童。在此期间，对抗生素的需求增加导致了药品短缺和严重短缺协议（SSP）的引入。现有的监测系统，如法定报告疾病报告和全科医生小时监测公告，描述了临床事件，但它们并不与相关的处方数据相关联。这项研究补充了-这项研究支持常规监测报告的结果，该报告表明，在COVID-19限制期间，GAS感染下降，随后在2022年12月出现高峰，证明OpenSAFELY平台和初级保健数据不仅可用于快速描述临床事件，还可用于在未来爆发的情况下快速描述相关处方。具有GAS适应症的抗生素处方，特别是苯氧甲基青霉素替代品和保留抗生素，在2022年12月的峰值高于2019年。
ObjectiveTo investigate the impact of the COVID-19 pandemic on Group A streptococcal (GAS) cases and related antibiotic prescriptions.DesignA retrospective cohort study with supporting dashboards with the approval of NHS England.SettingPrimary care practices in England using TPP SystmOne software from January 2018 through March 2023.ParticipantsPatients included were those registered at a TPP practice for each month of the study period. Patients with missing 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 measuresWe calculated monthly counts and crude rates of GAS cases (sore throat/tonsillitis, scarlet fever, invasive group A strep) and prescriptions linked with a GAS case, before (pre-April 2020), during and after (post-April 2021) COVID-19 restrictions. We calculated the maximum and minimum count and rate for each season (years running September-August), and the rate ratio (RR) of the 2022/23 season to the last comparably high season (2017/18).ResultsRecording of GAS cases and antibiotic prescription linked with a GAS case peaked in December 2022, higher than the 2017/2018 peak. The peak rate of monthly sore throat/tonsillitis (possible group A strep throat) recording was 5.33 per 1,000 (RR 2022/23 versus 2017/18 1.39 (CI: 1.38 to 1.40)). Scarlet fever recording peaked at 0.51 per 1,000 (RR 2.68 (CI: 2.59 to 2.77)), and invasive group A streptococcal infection (iGAS) at 0.01 per 1,000 (RR 4.37 (CI: 2.94 to 6.48)). First line antibiotics with a record of a GAS infection peaked at 2.80 per 1,000 (RR 1.37 (CI:1.35 to 1.38)), alternative antibiotics at 2.03 per 1,000 (RR 2.30 (CI:2.26 to 2.34)), and reserved antibiotics at 0.09 per 1,000 (RR 2.42 (CI:2.24 to 2.61)). For individual antibiotics, azithromycin with GAS indication showed the greatest relative increase (RR 7.37 (CI:6.22 to 8.74)).This followed a sharp drop in recording of cases and associated prescriptions during the period of COVID-19 restrictions where the maximum count and rates were lower than any pre COVID-19 minimum.More detailed demographic breakdowns can be found in our regularly updated dashboard report.ConclusionsRates of scarlet fever, sore throat/tonsillitis and iGAS recording 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 clinical and demographic subgroups.What is knownDuring the COVID-19 pandemic there has been a substantial change to the pattern of circulating viruses and bacteria that cause illnesses. A spike in group A streptococcal infections in England starting December 2022 was associated with 426 deaths, including 48 children as of 7th May 2023. Increased demand for antibiotics in this period led to medicines shortages and the introduction of Serious Shortage Protocols (SSPs). Existing surveillance systems such as notifiable disease reports and GP in-hours surveillance bulletins describe clinical events, but they do not link to relevant prescribing data.What this study adds-This study supports the findings of routine surveillance reports which indicated a drop in GAS infections during the COVID-19 restrictions, followed by a spike in December 2022, demonstrating that the OpenSAFELY platform and primary care data can be used to rapidly describe not only clinical events but also relevant prescribing in the case of future outbreaks.-Antibiotic prescribing with a GAS indication, particularly for phenoxymethylpenicillin alternatives and reserved antibiotics, was higher in the December 2022 peak than in …
各国参与TPP谈判的动机和政策决策过程
DOI：
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发表时间：
2022
期刊：
杏林社会科学研究
影响因子：
--
作者：
三浦秀之;浦田秀次郎;大澤武司;Yumi NAGASE;野添文彬;三浦秀之
通讯作者：
三浦秀之