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Get kids up-to-date on vaccinations, watch for signs of invasive Strep A: doctors

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Camille Bains, The Canadian Press


Published Saturday, January 20, 2024 7:21PM EST

 

The recent deaths of six children in Ontario and four children in British Columbia from a bacterial infection is grabbing parents’ attention. Doctors say severe cases of invasive Group A streptococcal infection are extremely rare. Here’s what to know about the disease that is showing up in record numbers this season and also puts adults, especially those aged 65 and older, at risk.

What is Group A streptococcus?

Streptococci bacteria are commonly found in the throat and on skin. Dr. Monika Naus, medical director of immunization programs and vaccine preventable diseases at the BC Centre for Disease Control, said some people have no symptoms but others may get strep throat, a mild illness often accompanied by a fever. It resolves on its own within a few days or is treated with antibiotics. A sore throat, on the other hand, usually comes with a cough, runny nose or other cold-like symptoms.

How does someone get infected with invasive Group A streptococcal infection, or iGAS?

The illness becomes invasive when bacteria enter the bloodstream or deep tissue, sometimes through an open wound or the nose and throat. It is passed on through direct contact with discharges from those membranes or with infected skin lesions, Naus said.

What are some ways to prevent infection?

Washing hands, especially before cooking or eating, is one protective measure, as is keeping any cuts or wounds clean and watching for redness or other signs of infection. Staying home when sick and getting vaccinated against influenza and COVID-19 is also important.

Naus said even a paper cut could lead to infection.

“I’m not meaning to scare anyone but it doesn’t have to be a serious trauma. Sometimes strep infections can be initiated by what’s called blunt trauma, which means the skin wasn’t even pierced. But the organisms were on the skin and entered the body that way.”

A viral infection, such as the flu, can allow Strep A bacteria to invade the body, making those infections more common in the winter months.

British Columbia has had 60 cases of the invasive illness in people under age 20 compared with thousands of cases of influenza and respiratory syncytial virus, or RSV, which is more likely to sicken young children and older adults.

What should parents be watching for?

“It’s a fine line trying to tell the difference between a child who’s miserable because they’re on their first or second day of a fever from the flu and a child who’s getting into trouble.” Naus said.

However, parents should be on the lookout for prolonged fever, difficulty breathing, sandpapery red rash or a swollen tongue, sometimes called strawberry tongue. A child who is groggy and has a tough time waking up should also raise concerns.

A child whose condition is deteriorating could also have pneumococcus disease, though children are vaccinated against it starting at two months.

While there is no vaccine for invasive Group A streptococcus, Naus urged parents to at least get their kids vaccinated against influenza and COVID-19.

“It can prevent those infections, and those infections can be a precursor to a more serious bacterial infection.”

Who is most at risk?

Dr. Upton Allen, head of infectious diseases at Toronto’s Hospital for Sick Children, said people with a weakened immune system are most susceptible to infection. In Ontario, children between five and nine have become ill, as have adults 65 and older, he said.

“Among adults, those with long-term illnesses such as cancer, diabetes, kidney disease and on special medications such as corticosteroids may be at higher risk,” Allen said. “Some of these infections may be mild but some may have severe outcomes.”

Families should be mindful that lesions sometimes caused by chickenpox may become infected and cause Step A infection, he said, urging parents to ensure their kids get routine vaccinations.

“Certainly, we have had concerns during the COVID period, and we all should advocate for there to be strong efforts to ensure that vaccines are up-to-date.”

What are severe but rare forms of Group A strep?

In very rare cases, Group A strep can cause necrotizing fasciitis, a flesh-eating disease; meningitis; cerebral spinal infection; toxic shock syndrome, which causes multi-organ failure; low blood pressure and kidney failure.

Naus said none of the four children who died in British Columbia were believed to have developed any of those conditions.

This report by The Canadian Press was first published Jan. 20, 2024.

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

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

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