 invasive group a streptococcus outbreaks associated with home healthcare england 2018 2019 healthcare associated invasive group a streptococcus igas outbreaks are common worldwide but only england has reported outbreaks associated with home healthcare hhc in this study 10 outbreaks during 2018 2019 in england were described outbreak identification was difficult but emm typing and whole genome sequencing improved detection network analyses indicated multiple potential transmission routes outbreak control required multiple interventions including improved infection control equipment decontamination and antimicrobial prophylaxis for staff transmission routes and effective interventions are not yet clear and igas outbreaks likely are underrecognized to improve patient safety and reduce deaths public health agencies should be aware of hhc associated igas 