TORONTO – Some Canadian officials are reporting an increase in invasive group A strep infections, echoing the European Center for Disease Prevention and Control and the US Centers for Disease Control and Prevention
TORONTO – Some Canadian officials are reporting an increase in invasive group A strep infections, echoing the European Center for Disease Prevention and Control and the US Centers for Disease Control and Prevention, which they are investigating cases in children.
In Canada, Public Health Ontario confirmed to The Canadian Press in an email on Tuesday that it is “currently seeing an increase in cases of group A invasive strep.”
Health officials in Montreal are asking health care providers to be “more vigilant” when it comes to detecting signs of the disease.
As of Dec. 15, four children age two and younger had invasive group A strep in Montreal, according to the city’s public health department. Two of those children died. In comparison, the department said, during the same time periods between 2017 and 2021, there were no cases or one case each year.
“It’s clear that we’re seeing a lot more group A strep right now than we’ve had in the last, let’s say, five to seven years,” said Dr. Fatima Kakkar, a pediatric infectious disease specialist at CHU Sainte- Justine from Montreal.
But it’s important to distinguish the different types of group A strep infections, he said, because the bacteria itself is quite common. The greatest danger comes in the rare cases where it becomes invasive.
What is group A strep?
Group A strep is a type of bacteria that grows in the nose, throat, and sometimes the skin. Children often carry it without infection.
Strep A also causes common childhood infections, such as strep throat and scarlet fever, experts say.
Scarlet fever can occur alongside strep throat or as a result of a skin infection. Symptoms of scarlet fever can include a red rash that feels like sandpaper, a fever of 38.3 degrees C or higher and a coating on the tongue that makes it look like a strawberry, experts say.
What is group A invasive strep?
Bacteria, including strep A, become “invasive” when they enter “somewhere in the body that normally doesn’t have bacteria,” said Dr. Allison McGeer, an infectious disease specialist and microbiologist at Sinai Health Systems in Toronto.
This includes the bloodstream, muscles and tissues. When strep A invades these sites, it causes serious diseases such as necrotizing fasciitis (often known as flesh-eating disease), streptococcal toxic shock syndrome, and sepsis.
Invasive strep A can also cause “really severe pneumonia” with “empyemas,” which are pockets of pus around the lungs, Kakkar said.
Why are there more cases of invasive strep A now?
The increase in invasive strep A cases is likely associated with the increase in RSV and influenza viruses affecting children, the World Health Organization said in a press release in early December.
There are a few possible reasons for this, experts say.
One is that regular Strep A infections are increasing after a hiatus due to public health measures taken during the COVID-19 pandemic, and coinfection can lead to complications, McGeer said.
“The combination of more flu being around and more group A strep being transmitted makes flu more severe and group A strep infections more severe,” he said.
Viruses like the flu can also make it easier for strep A that’s already present to become invasive, because they break down the lining of the mucous membrane, McGeer said.
“(That’s) what viral infections do, right? They destroy the surface cells of the nose and throat … and that, of course, allows bacteria to invade,” he said.
Kakkar said that’s what he’s seeing among his patients.
“I think what happens anecdotally is that a lot of my patients had the flu and a week later developed their severe group A strep infection,” he said.
Another virus associated with invasive strep A infections is chickenpox, WHO said in its press release.
This can take the form of necrotizing fasciitis, Kakkar said.
“When the chicken pox skin is broken, the strep can get in very easily.” she said
There hasn’t been an increase in chickenpox in Montreal, Kakkar said, so it’s not currently one of the factors driving invasive strep A cases there.
How are Strep A infections treated?
Often with antibiotics, but it’s important to be as sure as possible that the infection is actually caused by strep, Kakkar said.
If a child has a sore throat, it could be viral rather than bacterial, so doctors check to rule it out and determine if it’s strep.
If children are given antibiotics for any infection, it’s critical that they finish the full course, even if they feel better sooner, she said.
There is a shortage of infant amoxicillin in canada. What should caregivers do if an antibiotic is needed?
Liquid amoxicillin, a type of penicillin, is often prescribed to children because it is well tolerated, Kakkar said. But there are several other options, from crushing tablets to make a liquid suspension to using other antibiotics that also work, he said.
The Canadian Pharmacists Association published a list of alternatives for prescribers in November. According to this document, antibiotics are often not required for strep throat because it can get better on its own.
But if antibiotics are needed, a different type of penicillin can be used, the pharmacists’ association says. If the child has a penicillin allergy, other possibilities include cephalexin, cefadroxil, clindamycin, clarithromycin, and azithromycin, she says.
How can we protect our children against invasive Strep A?
Doctors stress that it is still very rare for strep A infections to become invasive and cause life-threatening illness.
Strep A is easily spread by close contact, as well as by sharing items such as utensils or toys that children pick up saliva on, doctors say.
To protect yourself from Strep A infection, many of the same prevention measures that are used against COVID-19, the flu, and RSV apply, such as washing your hands frequently and staying in home when he is sick, they say.
Another critical way to protect yourself from serious strep A infections is to protect yourself from the flu by getting a flu shot, both McGeer and Kakkar say.
“I don’t think I’ve ever felt as strong as I have this year. I’ve just seen so many complications in the hospital these past few weeks and it’s unfortunate.” Kakkar said.
“I strongly urge everyone to vaccinate their child because it is the way to prevent these serious secondary complications,” he said.
This report by The Canadian Press was first published on December 20, 2022.
Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press