A Strep A outbreak has left 12 people dead with at least 20 more infected by the rare contagious bacterial strain.
The 32 patients who suffered an invasive infection were from across Essex and most of them were elderly and receiving care for "chronic wounds".
Group A streptococcal (GAS) bacteria is commonly found in the throat and on the skin, although many people can carry it without illness.
It can cause infections including strep throat, pneumonia and scarlet fever, and in rare cases it can develop into complications such as rheumatic fever, toxic shock syndrome and necrotising fasciitis, or flesh-eating disease.
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It is spread by direct contact with secretions from the nose or throat of infected people, or from contact with an infected wound or sore.
The outbreak started in Braintree with further cases found around Chelmsford and Maldon, the Mid Essex Clinical Commissioning Group (CCG) said in a report.
It said most of those affected are "elderly and had been receiving care for chronic wounds in the community and care homes".
The CCG has not revealed when the first cases were discovered.
It said 12 of 32 patients have died.
Cases diagnosed in Basildon last year and Southend-on-Sea in February this year do not appear to have a direct link to the outbreak in Braintree, the CCG said.
Public Health England is investigating the outbreak.
The CCG said an incident management team has been set up and "additional" infection control measures are in place to prevent the infection spreading.
Hundreds of people, including care home staff, have been swabbed, and community staff employed by adult services providers have been given precautionary antibiotic treatment.
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Rachel Hearn, director of nursing and quality for the Mid Essex Clinical Commissioning Group, said: “Our thoughts are with the families of those patients who have died.
“The NHS in Essex is working closely with Public Health England and other partners to manage this local incident, and extra infection control measures have been put in place to prevent the infection spreading in the area.
“The risk of contracting iGAS (invasive Group A streptococcal) is very low for the vast majority of people and treatment with antibiotics is very effective if started early.
"We will continue to work with our partners in Public Health England to investigate how this outbreak occurred and take every possible step to ensure our local community is protected.”
