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Why deadly, invasive strep A infections are surging in Canada and beyond – CBC News

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This story is part of CBC Health’s Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven’t subscribed yet, you can do that by clicking here.


When Colin Hunter got a sore throat and a fever last spring, he didn’t think much of it.

A week later, after packing and unpacking cardboard boxes, the middle finger of his right hand started to feel a bit irritated. By mid-afternoon, it was swollen. And by early evening, just hours later, it was clear something was very, very wrong. 

“It went from nothing to, by about 5 p.m., a big plump grape on the end of my finger, turning black, swollen around the fingernail on all sides, and throbbing with each heartbeat,” Hunter recalled. “That’s when I went to the emergency room.”

Physicians at his local hospital feared it was a case of necrotizing fasciitis, also known as flesh-eating disease. So they cut open his finger, ran some tests and came back with a surprising diagnosis: He had a strep A infection. 

Hunter had never heard of such a thing in someone’s hand. Then he realized his prior throat pain and fever might have been an undiagnosed case of strep throat — and that the bacteria could have gotten inside his finger through something as small as a paper cut. 

Colin Hunter was hospitalized for five days last spring after a little cut on his finger got infected with what turned out to be strep A bacteria. Doctors used black marker to track the infection’s route. (Submitted by Colin Hunter)

The 47-year-old Guelph, Ont., resident ended up spending five days on intravenous antibiotics. During his hospital stay, physicians said the infection was likely spreading through his bloodstream, marking the route along Hunter’s arm with a black marker.

He fully recovered after treatment in the hospital and another round of antibiotics at home. But what haunts Hunter now is what would have happened if he hadn’t sought medical help as soon as he did.

“I might not have kept my finger,” he told CBC News. “Or my life.”

Fast-spreading and potentially deadly strep infections — known as invasive group A strep, or iGAS — are on the rise in Canada, hitting a new high in 2023, as CBC News first reported last week. 

Provinces have also reported dozens of deaths in just the last few months, including at least 10 children across Ontario and B.C. Other countries, such as the U.K. and Japan, have also reported notable surges.

The big question is: Why? Why are we seeing a spike in these serious infections, both in Canada and abroad?

Scientists say there’s no single smoking gun, but rather a complex set of factors, some of which surfaced even before the COVID-19 pandemic. 

“We don’t fully understand that, at this point,” said Dr. Jennifer Guthrie, an assistant professor of microbiology and immunology at Western University in London, Ont. “And it’s probably become more pressing to understand that recently with the rise.”

Rates were quietly rising for years

Group A streptococcus is a family of bacteria that typically causes milder illnesses, such as painful strep throat, skin infections or scarlet fever. In those cases, antibiotics usually clear things up.

The invasive form occurs when strep bacteria enter the soft tissues or the bloodstream. “It’s the highway to every single point in your body,” said Michael Johnson, an associate professor in the University of Arizona’s department of immunobiology.

Though relatively rare, those iGAS infections often progress rapidly, leading to a range of serious illnesses ranging from toxic shock syndrome to sepsis to brain inflammation. Among the various types of bacteria that can make humans sick, this family probably causes more kinds of diseases than any other, Johnson noted.

“It does not play well with others.”

Most estimates suggest around one in 10 people die from iGAS, at times within 12 to 24 hours of being infected.

WATCH | Severe strep infections on the rise: 

Severe strep A infections are on the rise

10 days ago

Duration 2:51

Doctors say they’re seeing significantly more invasive strep A infections, caused by a bacteria that usually leads to milder illnesses. But in some cases it can enter the bloodstream and quickly become deadly.

And rates of those infections were quietly rising for years, research suggests. One Canadian study, published in September 2022, used a national disease surveillance database to look at rates of iGAS between 2009 and 2019.

The team, including University of Toronto researcher and infectious diseases specialist Dr. Allison McGeer, found the incidence of those infections went from four cases per 100,000 people to a little more than eight — doubling in just a decade.

The latest tally of 4,600 iGAS samples processed for 2023, provided to CBC News by the Public Health Agency of Canada, suggests the rate could now be as high as 12 cases per 100,000 people.

McGeer told CBC News there are multiple theories about the increase.

The family of bacteria behind strep-related illnesses often thrives in congregate settings, including long-term care facilities and the shelter system, since it spreads through close contact, including open wounds and airborne droplets from someone coughing, talking or sneezing.

So there’s speculation that rising levels of homelessness and intravenous drug use in Canada could mean more people living in situations “where you have more breaks in the skin and issues with accessing good hygiene,” leaving those populations vulnerable to strep infections, McGeer said. 

Dr. Ivan Ying, an infectious diseases physician with Mackenzie Health, a hospital network north of Toronto, said global travel may be an additional factor, given the massive spike in international tourism observed in the 20 years leading up to the pandemic. 

Group A strep is also a diverse family of bacteria, with hundreds of subtypes. The most common ones circulating in any given season tend to ebb and flow, scientists say, and they’re linked to different types of disease.

“I think travel, and close settings, and different strains crossing the border might have something to do with [the rise],” Ying said.

The U.K., for instance, observed a new lineage of group A strep prior to the pandemic that “does appear to be associated with some increased severity,” McGeer said. (That lineage has also been reported in Canada.) 

“It was on its way up,” McGeer said. “Then we got the pandemic.”


LISTEN | Senior health and medical reporter Lauren Pelley on the rise of invasive strep A:

Front Burner19:53Invasive strep A: what you need to know


‘Perfect storm’ of respiratory, bacterial infections

That’s when the strep situation got even more complex.

Public health restrictions put in place to curb transmission of SARS-CoV-2, the virus behind COVID-19, had a ripple effect on other pathogens, too. Influenza disappeared for more than a year. Multiple countries reported reduced rates of pneumococcal disease.

And group A strep “was down by 50 or 60 per cent for the next year-and-a-half,” McGeer said.

Then it started to re-emerge, along with a variety of other infectious diseases. At the same time, Guthrie noted, vaccination rates for both COVID and flu petered out. 

Several scientists agreed it may be a sheer numbers game, where higher rates of other illnesses — including old staples like flu and respiratory syncytial virus (RSV), as well as COVID-19 — are providing strep bacteria with a massive pool of people already weakened by other infections.

“It’s a perfect storm of having a lot of these viruses also co-circulating that also leave people vulnerable to strep A,” said Guthrie.

WATCH: Warnings about invasive strep A infections across Canada:

Health authorities across Canada are warning about a sharp increase in cases of invasive streptococcus A

9 days ago

Duration 4:44

Last year, 4,600 cases of invasive group A strep (iGAS) infections were recorded in Canada — a record number. Alberta Health says rates of iGAS have been increasing since 2017, with 768 confirmed cases reported in 2023.

In B.C., for instance, the province’s four recent strep-related deaths among children involved two cases where group A strep was identified alongside influenza, and another two where it was identified alongside another viral respiratory illness, human metapneumovirus.

One piece of the puzzle may be the fact that run-of-the-mill strep infections can damage the cells of the upper respiratory tract, noted McGeer.

Another may lie in changes to the immune system during an acute viral infection. 

“There is no question that having increases in viral infections are associated with increases in complicated bacterial infections, to some degree,” she added. “Any two infections tend to be worse than any one infection.”

No strep A vaccine yet

Underpinning all those factors? The lack of a strep A vaccine.

“Group A strep is something we should, God damn it, have a vaccine for,” said McGeer. “Because it’s on the list of severe diseases where you can get really sick, really quickly — even if you’re perfectly healthy — and you can’t do anything about it.”

Researchers around the world have been trying to make a successful vaccine against strep A for decades, but there are major challenges to getting one to market.

One Canadian-Australian team that includes researchers at the University of Alberta is in the midst of early clinical trials for its vaccine candidate, and clinical lead Dr. Vanessa Meier-Stephenson was upfront about the complexities at play.

A major issue, she explained, is that researchers need to identify and track all the strains that cause severe disease — which could number upwards of 230 — while also watching for fluctuations in the strains that are most common in the population. 

WATCH: Spike in invasive strep A infections reported in 2023:

Concerning rise in cases of invasive form of strep A

9 months ago

Duration 2:22

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.

On top of that, the arrival of strep A bacteria can sometimes spark a faulty immune response,where the body produces antibodies that, instead of targeting the virus, attack the body’s own tissues. That inflammatory reaction leads to autoimmune conditions such as rheumatic fever, which can cause joint pain, swelling and damage to the heart valves.

Thanks to antibiotic use that cuts short most strep infections, those impacts are now much more rare in countries like Canada. But there’s concern strep vaccines could mimic that mechanism and lead to a similar autoimmune response in some recipients.

“There’s a huge safety component that gets associated with that,” Meier-Stephenson said.

Still, she and other scientists are hopeful that a strep A vaccine will eventually reach Canadians — if there’s enough public interest and pharmaceutical support.

In the meantime, multiple clinicians say they expect strep A infection rates will slow down eventually and that invasive forms of disease will remain relatively rare.

“It’ll probably rise a bit, but at a certain point stabilize,” said Guthrie. “But I’d love to know for sure.”

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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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