Dynamics of public health messaging and healthcare activity in children during the 2022 iGAS surge: an observational study in England

BACKGROUND: Public health messaging during infectious disease outbreaks can influence healthcare demand. The winter 2022 surge in Group A Streptococcus (GAS) in England provided an opportunity to examine the relationship between communications and National Health Service (NHS) activity, informing future strategies for resilience and risk communication. METHODS: This observational study analysed UK Health Security Agency (UKHSA) invasive GAS (iGAS) notifications, NHS 111, General Practice (GP), and emergency department (ED) surveillance data, prescription records, internet searches, and media reports. Temporal associations were assessed descriptively, with weekly differences from winter averages calculated. RESULTS: Following initial media reports and UKHSA messaging, internet search interest rose sharply (4%-63%). In the subsequent week, there were increases in NHS 111 contacts (fevers +256%, sore throats +953%), acute respiratory infection ED visits (+155%), GP pharyngitis consultations (+356%), and community penicillin prescriptions (+134%) compared to winter averages. Compared to the previous week, consultations for scarlet fever declined. CONCLUSIONS: This is the first study to link outbreak communications with system-wide NHS activity in real time. Messaging likely prompted appropriate care-seeking, but the rapid return to baseline and the low predictive value of consultations for iGAS suggest that many were for self-limiting illness. Findings highlight the need for tailored messaging, interdisciplinary collaboration, and scalable healthcare capacity during outbreaks.