Global Courant 2023-04-18 13:00:38
As several countries continue to report high levels of invasive group A streptococcal infections (iGAS) – which cause serious illness and, in rare cases, death within days – Canadian doctors are also sounding the alarm about an increase in serious cases this season.
The infections are linked to a common, often harmless bacteria known as group A strep. Usually it is known for milder illnesses such as strep throat or scarlet fever, which are usually treated with antibiotics.
But when bacteria enter the blood or deep tissue, people can develop more invasive, life-threatening conditions, such as high blood pressure necrotizing fasciitis or toxic shock syndrome. In those severe cases, complications can involve massive damage to the skin and soft tissues, leading to amputations or even death, sometimes within 12 to 24 hours of infection.
In Quebec, the number of iGAS infections recently increased by 56 percent compared to the pre-pandemic average for the same period, according to data collected by the province’s Department of Health and Social Services (MSSS).
A total of 327 cases were reported between the end of August 2022 and February 11, 2023, compared to an average of 223 for the same period between 2015 and 2019, before widespread public health measures during the COVID-19 pandemic spread a variety of infectious diseases.
The county has also reported multiple deaths among both senior citizens and children.
While cases peaked late last year, infected children are still arriving at a “steady pace” at Sainte-Justine University Health Center in Montreal, said Dr Fatima Kakkar, a childhood infectious disease specialist.
It’s the most stressed the hospital has been during a Strep A season than any other time in the past decade, she added.
Kakkar points to a lack of immunity in children, with more children contracting strep recently after avoiding the bacteria in recent years, coupled with a similar return of flu in late 2022 after a long hiatus.
“What usually happens is a few weeks after[having the flu]or some other virus, which is when those strep that could be in the throat become invasive,” she explained.
Dr. Fatima Kakkar, a pediatric infectious disease specialist at Sainte-Justine University Health Center in Montreal, continues to see young patients suffering from invasive Strep A infections. (Alison Northcott/CBC)
Increases in several countries
The latest available Ontario data showed that this was a challenging strep season in that province as well, with more than 500 cases at the end of February and a higher incidence across all age groups than the same period in the past five years before COVID-19 hit.
Early findings from the Public Health Agency of Canada (PHAC) also suggest an increase in the number of iGAS cases nationwide last November among children under 15, compared to pre-pandemic – although cases have since returned to normal levels.
And the challenges go beyond one province or country.
“I will say it’s actually a global phenomenon,” says Dr. Susy Hota, the medical director of infection prevention and control at the University Health Network in Toronto. “This isn’t just a North American thing.”
The UK was one of the first countries to warn of a increase in invasive strep A infections this season and has since reported more than 2,651 cases across all age groups, compared to the final tally of about 2,900 over the entire “last comparable peak season” in 2017 and 2018.
There have been 355 deaths this season, one more than the last count from 2017 to 2018.
Researchers also recently reported on spikes in iGAS in 2022 France And DenmarkWhile the US Centers for Disease Control and Prevention (CDC) said cases this year have “remained high in children in some parts of the country even after respiratory viruses declined in those areas.”
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Antibiotic deficiency
The CDC noted an additional wrinkle: a persistent shortage of liquid amoxicillin, which is often prescribed to children to treat early, milder group A strep infections.
That regular antibiotic has also been on Health Canada’s third list of deficiencies since mid-November, which refers to shortages “having the greatest potential impact on Canada’s drug supply and health care system”.
A Health Canada spokesperson told CBC News there are signs that supply is improving, although overall demand remains higher than normal, which could impact supply at some pharmacies.
The department is working with the provinces and territories, manufacturers and stakeholders in the supply chain and health care system to “maintain existing supply, closely monitor planned supply to ensure all available supply is released and distributed to pharmacies without delay and hospitals. and where possible access foreign-authorized supplies or alternatives,” said an emailed statement.
For iGAS infections, which require extensive medical treatment, amoxicillin isn’t actually part of the arsenal, Hota said, but rather a range of other antibiotics typically administered intravenously.
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Certain symptoms should ‘set off an alarm’
Those serious strep infections, several medical experts pointed out, remain quite rare. The bacteria spreads easily through respiratory droplets, but most people experience milder illness, while others may not even know they are infected.
“It’s actually a very common bacteria,” says microbiologist Dr. Cécile Tremblay, a professor in the Department of Microbiology and Immunology at the Université de Montréal. “Many people in the population carry it, and often it does us no harm.”
And while anyone can be affected by iGAS, the worst infections usually strike the most vulnerable: those individuals already battling another virus, suffering from multiple comorbidities, or with an open wound.
Dr. Donald Vinh, an infectious disease specialist at McGill University, said fever, headache, confusion and a reduced level of consciousness during a strep infection all indicate a shift to a more serious illness.
“Those constellations of symptoms should normally ring alarm bells,” he said.
