The U.S. Centers for Disease Control and Prevention have issued a warning about a recent increase in invasive infections of strep A in children after at least two kids in the U.S. and 15 in the U.K. have died.
Group A streptococcus is a type of bacteria that can cause a range of illness, from strep throat and scarlet fever to skin infections. An invasive case of strep A refers to when the bacteria spread to parts of the body that they don’t normally reach, like the bloodstream. This can cause severe and even fatal illness and requires immediate treatment with antibiotics, according to the CDC warning.
The CDC said it was first notified about a rise in infections in the U.S. in November 2022, when a hospital in Colorado saw a possible increase strep A cases, followed by a potential increase “in other states,” per the warning. It did not specify which states. The agency added that in some parts of the country, the increase in strep A is occurring at the same time as “increased circulation” of respiratory syncytial virus, influenza, COVID-19 and other respiratory viruses.
“While the overall number of cases has remained relatively low and (invasive Group A strep) infections remain rare in children, CDC is investigating these reports,” the agency said.
NBC News previously reported that hospitals in Arizona, Colorado, Texas and Washington confirmed that they’ve seen more cases than usual of invasive Group A strep. In Colorado, two children, who were less than school age, have died from the infection since Nov. 1; the last time anyone in the state died from strep A was in 2018. The Denver Health Department told NBC News it has received reports of 11 cases — all in children between 10 months and 6 years old — since Nov. 1. In Texas, one hospital has seen an increase of four times in the number cases of invasive strep A this year, NBC News reported.
The CDC estimates that there are several million cases of noninvasive strep A in the U.S. every year — which includes strep throat, scarlet fever and the bacterial skin infection impetigo. Over the past five years, there have been between 14,000 and 25,000 cases of invasive strep per year and 1,500 to 2,300 deaths per year.
In the U.K., at least 21 children have died from invasive strep A since September, per the U.K. Health Security Agency. According to the World Health Organization, at least five countries in Europe (U.K., France, Ireland, the Netherlands, Sweden) have seen an increase in invasive strep A cases, primarily in kids under 10.
What is invasive strep A?
Strep A refers to the diseases that come from being infected with the bacteria called Group A streptococcus. Noninvasive illnesses from strep A, according to the CDC, include:
Scarlet fever, which commonly causes rash and fever.
Impetigo, a highly contagious bacterial skin infection that starts as raised bumps on the skin followed by blisters containing pus followed by crusty lesions.
An invasive strep A infection — which is what the CDC is currently investigating — refers to when the bacteria spread outside the throat or skin (where they tend to cause only mild symptoms) and into the bloodstream, lungs, fluid in the spinal cord or “other places inside the body they would not typically live,” per the Colorado health department.
Conditions that result from an invasive strep A infection include:
Cellulitis (a bacterial infection in the tissue under the skin) with a blood infection.
Pneumonia, an infection in the lungs.
Necrotizing fasciitis, popularly known as flesh-eating disease.
Streptococcal toxic shock syndrome (STSS), “which can develop very quickly into low blood pressure, multiple organ failure, and even death,” per the CDC.
Strep A is spread through contact with droplets from an infected person when they cough, sneeze or talk. Cases of Group A strep tend to follow a seasonal pattern, peaking between December and April in the U.S. It’s most common in kids 5 to 15 years old.
Why is strep A causing more severe infections?
It’s not currently known whether the spike in cases is due to one specific Group A strep strain, Dr. Michael Green, medical director of infection prevention and antimicrobial stewardship at the UPMC Children’s Hospital of Pittsburgh and a professor of pediatrics and surgery at the University of Pittsburgh, tells TODAY.com.
There are several hundred strains of Group A strep, and it’s possible that “a particularly nasty strain” has become more prominent in the parts of the country reporting increases, Green says, adding that until all the information on the strains from those places has been analyzed we won’t know.
Unlike COVID-19, where one variant can become dominant, “different areas of the country can have different strains of Group A in circulation,” Green says. “You can have a nasty Group A strep in Ohio, but not in Pittsburgh. But you worry that it might get here from people who are traveling.”
Green says the Children’s Hospital of Pittsburgh has not seen a bump in the number of cases this year as compared to those 2014 to 2017, but there may be an increase in the severity of this year’s cases.
It’s likely that the rise in cases in some locations is tied to the increase in viral illnesses — the flu, RSV and possibly COVID-19, Green says. Viruses like the flu can damage the small airways and make them more vulnerable to bacterial infections, he explains.
“Whenever we see a huge amount of respiratory viruses, we know we are going to see a bump up in bacterial infections,” Green says.
A factor that has confused the issue is that viruses such as RSV and influenza have sparked early this year, says Dr. Jason Zucker, an assistant professor of medicine at the Columbia University Vagelos College of Physicians and Surgeons in New York City.
“We’re seeing a lot of things in different seasons this year than we normally would,” Zucker tells TODAY.com. “So it’s not clear if there’s a change in the epidemiological pattern.”
The CDC noted in its warning that, in the past, the U.S. has seen increased rates of invasive strep A when flu activity has also been high. The current U.S. flu season is one of the worst in recent years.
Currently there doesn’t seem to be an increase in invasive Group A strep in New York City hospitals, Dr. Ethan Wiener, chief of emergency medicine at NYU Langone Health Hassenfeld Children’s Hospital, tells TODAY.com. “In speaking to people locally, there have been only sporadic cases that I am aware of.”
Signs of severe strep A infections
Because a viral infection can make a bacterial infection more likely, parents of kids who recently had a viral illness should be vigilant about possible Group A strep infections, Dr. Ishminder Kaur, a specialist in pediatric infectious diseases at the UCLA, David Geffen School of Medicine, tells TODAY.com.
Signs of a Group A strep infection, per the Colorado health department, include:
Sore throat
Fever
Chills
New rashes
Skin bumps
Painful red patches on the skin
High fever and labored breathing, as well as “difficulty coordinating swallowing with breathing” in young kids, “should trigger parents to call their provider or to seek emergency care, depending on the seriousness of the situation,” Kaur says.
Wiener adds that a high fever by itself doesn’t signal Group A strep and is “in no way harmful or dangerous.” Parents should remember that if a child is very sick, it could be the flu, he says.
Signs a child’s strep A infection may be invasive include:
A change in mental status. “Maybe you’re not able to arouse the child, or the child may not be responding normally,” Wiener says. “That’s different from the child feeling blah or lying on the couch all day.”
Early signs of necrotizing fasciitis, which, per the CDC, include: a red, warm or swollen area of skin that spreads quickly; severe pain, including pain beyond the area of the skin that is red, warm, or swollen; fever. Later-stage signs are: ulcers, blisters, or black spots on the skin; changes in the color of the skin; pus or oozing from the infected area; dizziness; fatigue; diarrhea or nausea.
Early signs of streptococcal toxic shock syndrome, which, per the CDC, include: fever and chills, muscle aches, nausea and vomiting. Later signs, which usually develop 24 to 48 hours after the first symptoms, include: low blood pressure; faster than normal heart rate; rapid breathing; signs of organ failure, such as inability to produce urine or yellowing eyes.
While both necrotizing fasciitis and streptococcal toxic shock syndrome are rare, their symptoms can get worse quickly. So, in light of the strep A investigation, the CDC is urging parents to know the symptoms of both diseases and seek medical care quickly if they think their child has either.
Parents should also contact a health care provider right away if their child develops new or worsening symptoms during a viral infection, the Colorado health department advised.
How to prevent strep A infections
The CDC is also urging parents to make sure their children get chickenpox vaccines and flu shot, as a strep A infection can be a complication of both viruses. Group A strep infections had been going down since 1995, when the chickenpox vaccine became available, Wiener says.
Some children might need to flu shots this year, and it’s not too late in the season to get them, TODAY.com previously reported.
In addition to getting vaccinated, to prevent strep A infections, the CDC recommends washing your hands often for at least 20 seconds or using an alcohol-based hand sanitizer, especially after coughing or sneezing and before preparing food or eating. You should also cover your coughs and sneezes with a tissue and dispose of it right away. If you don’t have a tissue, use your upper sleeve or elbow and not your hands.
When in doubt about your child’s condition, seek medical care. Even if it turns out it wasn’t necessary, “it’s better than having a bad outcome,” Wiener says.
This story first appeared on TODAY.com. More from TODAY:
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
