Research and analysis

HPR volume 20 issue 5: news (28 May 2026)

Updated 28 May 2026

Marked response to recent reminder on beta-haemolytic streptococci referral to UKHSA’s reference service

Following a UKHSA Briefing Note circulated to laboratories at the beginning of August 2025 reminding them of the recommendations (outlined in the Bacterial Reference Department manual) for referral of beta-haemolytic streptococci isolates from sterile sites, there has been a marked increase in the number of referrals to the UKHSA Staphylococcus and Streptococcus reference service (SSRS), Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit (1).

In the 6 months before the reminder was issued (February to July 2025) there was an average of 39 group B streptococcal (GBS) sterile site isolates referred per month, which increased by 234% to an average of 130 per month in the 6 months after (September 2025 to February 2026; see figure). Similarly, for group C/G streptococcal (GCGS) sterile site referrals, an average of 10 per month increased by 1,298% to 145 per month during the same time periods.

The collection and characterisation of these isolates aid:

• bacterial identification and typing
• genomic relatedness between isolates
• outbreak detection and management
• disease surveillance
• development of new vaccine targets and monitoring of future vaccine coverage.

The significant increase in referrals to UKHSA reference laboratories, prompted by the Briefing Note, was very welcome and the Agency acknowledges the importance of this and thanks laboratories for their engagement with the request.

Monthly group B and group C/G streptococcal sterile site referrals (England): April 2024 to February 2026

Prior to the UKHSA Briefing Note being issued, Group A streptococcal (GAS) sterile site isolate referral was routine for laboratories (1). However, GBS and GCGS sterile site referral had declined, motivating the reminder. Increasing the awareness of the recommendations, and of specimen referral rates, is particularly important as typing of isolates enhances surveillance, and informs outbreak detection, management and investigation. This is particularly important for GBS in the light of phase III GBS vaccine trials, and recent outbreaks of group B and group C/G streptococci in England (2,3).

The guidance highlighted within the UKHSA Briefing Note are:

• Bacterial Reference Department manual
• the UK Standards for Microbiology Investigations (UK SMI) ID4: Identification of Streptococcus species, Enterococcus species and morphologically similar organisms
• UK SMI B58: Detection of carriage of Group B Streptococci (Streptococcus agalactiae)
• the UK public health guidance for GAS in community and healthcare settings

In addition, GAS, GBS, and GCGS species exhibiting exceptional resistance phenotypes should be referred to the UKHSA Antimicrobial Resistance and Mechanisms Service, AMRHAI Reference Unit, for confirmation, that is, isolates that:

• are resistant to penicillin according to EUCAST clinical breakpoints v.15.0 (groups A, C/G: MIC >0.03 mg/L or zone diameter 0.125 mg/L or zone diameter <18mm)
• exhibit resistance to cephalosporins, vancomycin, teicoplanin, telavancin, dalbavancin, linezolid, tedizolid, quinupristin-dalfopristin or tigecycline

References

1. UKHSA (2025). ‘Referrals of group A, B, C and G streptococcal isolates to the Staphylococcus and Streptococcus Reference Section (SSRS)’ [internal document]

2. Collin SM, Lamb P, Jauneikaite E, le Doare K, Creti R, Berardi A, Heath PT and others (2019). ‘Hospital clusters of invasive Group B Streptococcal disease: a systematic review’ Journal of Infection: volume 79, number 6, pages 521 to 527

3. Guy RL, Rudman J, Broughton K, Moganeradj K, Mirfenderesky M, Brown C S, and Lamagni T (2025). ‘Descriptive analysis of incidence, hospital acquisition and health inequalities in invasive group C and G streptococcal infections England, 2016 to 2023’ Lancefield International Symposium on Streptococci and Streptococcal Diseases 2025, Brisbane Australia

Infection reports in this issue

Group A streptococcal infections: third update on seasonal activity in England, 2025 to 2026

Carbapenemase-producing Gram-negative organisms in England since October 2020: quarterly update, Q4 2025

Vaccine coverage report

Shingles vaccine coverage report (adults eligible from September 2025 to February 2026 and vaccinated to the end of April 2026): England