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Doctors worry more kids may be getting sick with invasive strep A. Here are the facts



TORONTO — Some Canadian officials are reporting an uptick in invasive Group A streptococcus infections, echoing the European Centre for Disease Prevention and Control and the Centers for Disease Control and Prevention in the U.S., which are both 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 for Invasive Group A Strep.”

Health officials in Montreal are asking health-care providers to be “extra vigilant” in screening for signs of the disease.

As of Dec. 15, four children aged two years and under have had confirmed invasive Group A streptococcus in Montreal, according to the city’s public health department. Two of those children died. By comparison, the department said, during the same time periods between 2017 and 2021, there were either no cases or one case each year.


“It’s clear that we’re seeing much more Group A strep right now than I’ve had in the last, let’s say, five to seven years,” said Dr. Fatima Kakkar, a pediatric infectious diseases specialist at CHU Sainte-Justine in Montreal.

But it’s important to distinguish the different types of Group A strep infections, she said, because the bacteria itself is quite common. The biggest danger comes in the rare cases when it becomes invasive.

What is Group A streptococcus?

Group A streptococcus is a type of bacteria that grows in the nose, throat and sometimes the skin. Often, kids are carrying it around without any infection happening.

Strep A also causes common childhood infections, such as strep throat and scarlet fever, experts say.

Scarlet fever can show up alongside strep throat or as the result of a skin infection. Symptoms of scarlet fever can include a red rash with a sandpaper-like feel, a fever of 38.3 degrees C or higher and a coating on the tongue that makes it appear strawberry-like, experts say.

What is invasive Group A streptococcus?

Bacteria, including Strep A, become “invasive” when they get into “somewhere in your body that normally has no bacteria,” said Dr. Allison McGeer, an infectious diseases specialist and microbiologist at Sinai Health Systems in Toronto.

That includes the bloodstream, muscles and tissues. When Strep A invades those places, 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, said Kakkar.

Why are there more cases of invasive Strep A now?

The rise in invasive strep A cases is likely associated with the increase in RSV and flu viruses hitting kids, the World Health Organization said in a news release earlier in December.

There are a few possible reasons for that, experts say.

One is that regular Strep A infections are on the rise after a hiatus due to public health measures taken during the COVID-19 pandemic – and co-infection can lead to complications, said McGeer.

“The combination of there’s more flu and there’s more Group A strep being transmitted makes for both more serious flu and more serious Group A strep infections,” she said.

Viruses like the flu can also make it easier for Strep A that’s already present to become invasive, because they break the lining of the mucous membrane, McGeer said.

“(That’s)what viral infections do, right? They destroy the surface cells of your nose and throat … and that of course allows bacteria to invade,” she said.

Kakkar said that’s what she’s seeing among her patients.

“I think what’s happening anecdotally is many of my patients had influenza and then a week later developed their severe group A strep infection,” she said.

Another virus associated with invasive strep A infections is chicken pox, the WHO said in its news release.

That can take the form of necrotizing fasciitis, Kakkar said.

“When the skin is broken from chicken pox, strep can get in very easily.” she said.

There hasn’t been a surge in chicken pox in Montreal, Kakkar said, so it’s currently not one of the drivers of the 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 that out and determine if it’s strep throat.

If children are prescribed antibiotics for any infection, it’s critical that they finish the entire course even if they feel better before that, she said.

There’s a shortage of children’s 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’s well tolerated, Kakkar said. But there are several other options, from pharmacists crushing tablets to make a liquid suspension to primary care providers prescribing other antibiotics that also work, she said.

The Canadian Pharmacists Association issued a list of alternatives for prescribers in November. According to that 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 an allergy to penicillin, other possibilities include cephalexin, cefadroxil, clindamycin, clarithromycin and azithromycin, it says.

How can we protect our kids against invasive Strep A?

Doctors emphasize that it’s still very rare for Strep A infections to become invasive and cause life-threatening disease.

Strep A passes easily through close contact, as well as through sharing items like utensils, or toys that kids get their saliva on, doctors say.

To protect against Strep A infection, many of the same prevention measures used against COVID-19, flu and RSV apply, including frequent handwashing and staying home when sick, they say.

Another critical way to protect against serious strep A infections is to protect against influenza by getting a flu shot, both McGeer and Kakkar say.

“I don’t think I’ve ever felt so strongly about it as I have this year. I’ve just seen so many complications in hospital these last few weeks and it’s unfortunate.” Kakkar said.

“I strongly urge everybody to get their child vaccinated because it’s the way to prevent these severe secondary complications,” she said.

This report by The Canadian Press was first published December 20, 2022.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Nicole Ireland, The Canadian Press

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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD



Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but significantly linked with preservation of kidney function and improved survival in a propensity-score matched, retrospective analysis of observational data from more than 2000 people with type 2 diabetes in Taiwan.

Why This Matters

  • Cardiovascular disease is a leading cause of mortality in people with type 2 diabetes and among those with chronic kidney disease.
  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.
  • Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Trials that have assessed GLP-1 agonists in people with type 2 diabetes have generally excluded those with advanced DKD and completely excluded those with end-stage kidney disease (eGFR < 30 mL/min/1.73m2).
  • Treatment with GLP-1 agonists has been associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively fair kidney function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and lower levels of kidney function, research has shown neutral composite cardiovascular outcomes levels. However, limitations of previous studies include being mainly based on subgroup analysis or including a limited sample of patients.

Study Design

  • Retrospective analysis of observational data from nearly 9000 people in Taiwan with type 2 diabetes and an eGFR < 30 mL/min/1.73m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor in 2012-2021 and had the data necessary for this analysis in their records.
  • The data came from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients, from 2001 to 2019.
  • Researchers used propensity scoring to match 602 people treated with a GLP-1 agonist with 1479 people treated with a DPP-4 inhibitor.

Key Results

  • During a mean follow-up of 2.1 years, the rate of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) did not significantly differ between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a nonsignificant hazard ratio of 0.88. Rates of each of the three components of the composite endpoint also did not significantly differ between the two groups.
  • Progression to end-stage kidney disease with dialysis was significantly lower in those treated with a GLP-1 agonist compared with a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively, and a significant hazard ratio of 0.72.
  • The incidence of a greater than 50% drop in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared to 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.
  • Median time until patients needed new-onset dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was a significant difference.
  • The rate of all-cause death was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71 that was significant.


  • Because the study was a retrospective analysis of observational data it cannot prove causality.
  • The study could be subject to residual confounding despite propensity-score matching.
  • The data came from health records that could have included coding errors.
  • Treatment compliance was unknown.


This is a summary of a preprint research study, “The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan on Research Square and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on


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Research by UBC professor lays groundwork for life-saving breast cancer treatment



A drug originally designed to prevent osteoporosis is now expected to save and improve the lives of millions of people with breast cancer, thanks in part to decades of foundational research by Dr. Josef Penninger, a professor in UBC’s Faculty of Medicine and director of the Life Sciences Institute.

The achievement highlights how UBC scientists are developing effective new treatments — and unlocking the full potential of existing drugs – through research into the fundamental biological principles behind disease. By advancing scientific discoveries from the lab to the clinic, UBC researchers are bringing life-changing treatments to patients everywhere.

The drug, called Denosumab, was recently shown in a long-term Phase 3 clinical trial to improve survival among postmenopausal women with hormone receptor-positive early breast cancer receiving aromatase inhibitor treatment. Moreover, the drug markedly improved patients’ quality of life by reducing broken bones by 50 per cent, a common side effect of breast cancer treatment. The results of the trial were recently reported in The New England Journal of Medicine.


Denosumab is a monoclonal antibody developed by American biopharmaceutical company Amgen to prevent bone loss. In the early 2000s, research by Dr. Penninger and his team revealed the therapeutic potential of Denosumab, as well as the drug’s surprising connections with breast cancer.

“More than two decades ago we started the experimental groundwork that revealed Donosumab’s potential as a treatment for breast cancer patients,” says Dr. Penninger. “These results are incredibly exciting and will help improve the lives of millions of patients. I am very proud of all the people in my lab over the years who did that work and helped pave the way for this achievement.”

Discovering the link between osteoporosis and breast cancer

Denosumab works by binding to and inhibiting the activity of a protein called RANKL, which plays a key role in bone-resorbing cells called osteoclasts. By blocking RANKL, denosumab reduces the activity of osteoclasts and slows down bone resorption, helping to increase bone density and preventing osteoporosis.

Dr. Josef Penninger

Dr. Josef Penninger

Dr. Penninger and his team began to draw the connection between osteoporosis and HR-positive breast cancer when they generated the first RANKL “knock-out” mice in the late 1990s.

A knockout mouse is a laboratory mouse that has been genetically engineered to have certain genes deactivated, or “knocked-out”. Dr. Penninger’s team engineered mice that lacked the genes necessary to produce the RANKL protein in an effort to study the protein’s essential function in bone metabolism.

However, to the researchers’ surprise, they discovered that the RANKL-deficient mice failed to develop a lactating mammary gland in pregnancy – a process that depends on sex hormones.

“This proved an evolutionary link: showing how bone loss is regulated by sex hormones, and how pregnant mammals activate RANKL to form breast tissue for lactation among other functions,” says Dr. Penninger.

Based on this initial finding, Dr. Penninger’s team went on to show that RANKL played a key role in progestin-driven breast cancer, as well as breast cancer driven by BRCA1 mutations.

“Further researcher revealed how RANKL controls the stem cells in the breast that respond to sex hormones and thereby drives growth of the breast tissue at every menstruation cycle and in particular in pregnancy and lactation,” adds Dr. Penninger.

In the case of breast cancer, RANKL spurs mammary epithelial cells to divide, and helps to maintain the stem cells that give rise to breast tumours.

A dual benefit drug

One in eight Canadian women will be diagnosed with breast cancer in their lifetime according to the Canadian Breast Cancer Network. An estimated 70 to 80 per cent of these breast cancers are hormone receptor-positive (HR-positive), making it the most prevalent breast cancer subtype.

The current standard treatment for HR-positive breast cancer involves surgery and radiation, followed by treatment with aromatase inhibitors for 5 to 7 years. While aromatase inhibitors diminish sex hormones that drive new cancer growth, they can have serious adverse effects on bone health, including increased risk of osteoporosis and fractures.

The now-published clinical trial, led by the Austrian Breast and Colorectal Cancer Study Group, was conducted to see if Denosumab could help in two ways: by reducing these negative effects on bone health, while also improving breast cancer survival outcomes.

“These results are incredibly exciting and will help improve the lives of millions of patients.”
Dr. Josef Penninger

The results reveal that 6 mg of Denosumab every six months — the recommended treatment level for osteoporosis — improved disease-free survival, bone metastasis-free survival, and overall survival among participants. It also effectively reduced bone fractures over the long term.

“Blocking RANKL in breast cancer patients reduces broken bones by 50 per cent, massively improving their quality of life, and even at a very low treatment dose,” says Dr. Penninger. “We now know that RANKL drives breast cancer cell growth, is the critical mechanism behind bone loss, and has also an effect on anti-cancer immunity and immunological rewiring in pregnancy. These clinical results in patients show how blocking RANKL could save the lives of 50,000 women among one million women with the diagnosis of breast cancer.”

Based on the data, the researchers behind the trials are recommending that Denosumab be considered for routine clinical use in postmenopausal breast cancer patients receiving aromatase inhibitor therapy.

These trials were largely based on the foundational research published by the Penninger laboratory, including Kong et al. Nature 1999, Fata et al. Cell 2000, Jones Nature 2006, Schramek et al. Nature 2010, Sigl et al. Cell Research 2016, and Paolino et al. Nature 2021.

Dr. Penninger is now part of a large international prevention trial evaluating Denosumab in young women who carry BRCA1 mutations.


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Respiratory illness peaked in December at Chatham Kent Health Alliance: Suni – Chatham-Kent This Week



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Chatham-Kent Health Alliance officials are reporting a drop in patients visiting the emergency departments with respiratory illnesses between December and January, but admissions from the emergency rooms to the hospitals remain high.

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Caen Suni, the hospital group’s vice president of clinical programs and operations, said patients with illnesses like influenza, COVID-19 and respiratory syncytial virus dropped 50 per cent in January compared to December among children and by one-third among adults.


“The community is I think essentially working its way through seasonal illness at this point,” he said during a media teleconference Monday.

December also showed a 25 per cent increase over December 2021 for pediatric admissions and of those, 77 per cent were for respiratory illnesses, Suni said.

“That’s impactful and I think that’s what we’ve seen across the health sector in our entire region at this point,” he said.

Suni said the number of people seeking treatment at the emergency departments – which includes patients not admitted – is not “historically high,” but admissions to the hospitals increased in December by three per cent over the previous month.

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This translates to an extra two to three extra patients a day who require a bed. The health alliance also experienced almost 2.5 per cent more admissions in December than any month in the previous year.

However, December also had the lowest daily average of visits to the emergency departments of any month during the Health Alliance’s current fiscal year.

This means a higher proportion of patients require admission to the hospital and patients presenting at the emergency departments are more ill, Suni said.

Since December, the trends are now “pointing towards a decrease,” Suni said, “which we’re thankful for, as the community bounces back from seasonal illness.”

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