As various countries continue to report high levels of invasive group A streptococcal (iGAS) infections — which cause severe illness, and in rare cases death within days — Canadian physicians are also raising alarms over a rise in serious cases this season.
The infections are linked to a common, often-harmless bacteria known as group A streptococcus. Usually it’s known for milder illnesses like strep throat or scarlet fever, which are typically treated with antibiotics.
But when bacteria enter the blood or deep tissue, people can develop more invasive, life-threatening conditions such as necrotizing fasciitis or toxic shock syndrome. In those dire cases, complications can involve massive damage to the skin and soft tissues, leading to amputations or even death, sometimes in as little as 12 to 24 hours after infection.
In Quebec, the number of iGAS infections recently spiked 56 per cent compared to the pre-pandemic average for the same time period, according to data collected by the province’s Ministry of Health and Social Services (MSSS).
A total of 327 cases were reported between the end of August 2022 and Feb. 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 kept a variety of infectious diseases at bay.
Concerning rise in cases of invasive form of strep A
Doctors are seeing an increase in the number of patients experiencing an invasive form of group A strep. The illness is common but can be serious when bacteria spreads to the blood or deep tissue, and needs to be treated quickly.
The province has also reported multiple deaths among both seniors and children.
While cases peaked late last year, infected children are still coming in at a “steady pace” to Sainte-Justine University Health Centre in Montreal, said pediatric infectious diseases specialist Dr. Fatima Kakkar.
It’s the most stressed the hospital has been during a strep A season than any point in the last decade, she added.
“What usually happens is a few weeks after [having influenza] or other virus, that’s when that strep that might be there in the throat becomes invasive,” she explained.
Dr. Fatima Kakkar, a pediatric infectious diseases specialist at Sainte-Justine University Health Center in Montreal, continues to see young patients suffering from invasive Strep A infections. (Alison Northcott/CBC)
Surges in multiple countries
The latest available Ontario data showed this has been a challenging strep season in that province as well, with more than 500 cases reported by the end of February and a higher incidence rate across all age groups than during the same period in the last five years before COVID-19 hit.
Early findings provided by the Public Health Agency of Canada (PHAC) also suggest a rise in country-wide iGAS cases last November among children under 15, compared to pre-pandemic — though the cases have since returned to typical levels.
And the challenges go beyond any one province or country.
“I will say it’s actually a global phenomenon,” said Dr. Susy Hota, the medical director of infection prevention and control with the University Health Network in Toronto. “This is not just a North American thing.”
The U.K. was among the first countries to warn of a rise 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 roughly 2,900 across the whole of the “last comparably high season” in 2017 and 2018.
This season has hit 355 deaths, already one more than the final 2017 to 2018 count.
Quebec takes control of private seniors’ homes after 4 deaths
Quebec has taken control of two private Montreal seniors’ homes where outbreaks of streptococcus A led to the deaths of four residents. The province has also been alerted of abuse allegations at both homes.
Antibiotic shortage
The CDC noted an added wrinkle: An ongoing shortage of liquid amoxicillin, which is often prescribed to children to treat early, milder group A strep infections.
That common antibiotic has also been on Health Canada’s tier three shortage list since mid-November, which refers to shortages “that have the greatest potential impact on Canada’s drug supply and health-care system.”
A spokesperson for Health Canada told CBC News that there are signals the supply is improving, though 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 across the supply chain and health-care system to “conserve existing supply, closely monitor planned resupplies to ensure that all available supply is released and distributed without delay to pharmacies and hospitals, and access foreign-authorized supply or alternatives, where possible,” according to an emailed statement.
For iGAS infections, however, which require extensive medical treatment, amoxicillin isn’t actually part of the arsenal, said Hota, but rather a slate of other antibiotics that are typically given intravenously.
Group A streptococcus has been in the headlines recently after 15 kids died in the U.K. Dr. Joanne Langley, a pediatrician specializing in infectious diseases, discussed what guardians and adults should know about this bacteria that can cause a range of illnesses.
Certain symptoms should ‘ring an alarm’
Those severe strep infections, several medical experts stressed, do remain quite rare. The bacteria spreads easily through respiratory droplets, but most people experience milder illness, while others aren’t even aware they’re infected.
“It’s a very common bacteria, actually,” said 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 get hit by iGAS, the worst infections usually strike the most vulnerable — those individuals who are already battling another virus, or suffering from multiple comorbidities, or experiencing an open wound.
Dr. Donald Vinh, an infectious diseases specialist with McGill University, said fever, headaches, confusion and a decreased level of consciousness during a strep infection all signal a shift to more serious disease.
“Those constellations of symptoms usually should ring an alarm bell,” he said.
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.
