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Spike in severe illness caused by strep A bacteria is ‘global phenomenon’ — including in Canada

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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.

Kakkar points to a lack of immunity among children, with more kids now catching strep recently after avoiding the bacteria over the last few years, coupled with a similar return of influenza in late 2022 after a lengthy lull.

“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.

Researchers also recently reported on 2022 surges in iGAS in France and Denmark, while the U.S. Centers for Disease Control and Prevention (CDC) said cases this year have “remained high in children in some areas of the country even after respiratory viruses decreased in those areas.”

 

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.

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

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

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

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 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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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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