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.
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.
