Some Canadian officials are reporting an increase in invasive group A strep infections, like the European Centers for Disease Control and Prevention and the Centers for Disease Control and Prevention in the United States, both Both are investigating cases in children.
In Canada, the Ontario Ministry of Public Health confirmed to The Canadian Press in an email on Tuesday that it is “currently seeing an increase in cases of Invasive Group A Strep.”
Health officials in Montréal are asking health care providers to be “more vigilant” in screening for signs of the disease.
According to the city’s public health department, as of December 15, four children two years old and younger have been confirmed to have invasive group A strep infections in Montreal. Two of those children died. For comparison, the department said, for the same period from 2017 to 2021, there were no cases or one case per year.
Dr Fatima Kakkar, pediatric infectious disease specialist at CHU Sainte-Justine, said: “It is clear that we are seeing much more group A strep than what I have seen in five to seven years. via. Montreal.
But it is important to distinguish the different types of group A streptococcal infections, as the bacteria themselves are quite common. The greatest danger occurs in the few cases when it becomes invasive.
What is Group A Streptococcus?
Group A strep is a type of bacteria that grows in the nose, throat, and sometimes on the skin. Usually, children carry it around without getting an infection.
Strep A also causes common infections in children, such as strep throat and scarlet fever, experts say.
Erythema may occur with strep throat or from a skin infection. Symptoms of scarlet fever can include a red rash that feels like sandpaper, a fever of 38.3 degrees Celsius or higher, and a coating on the tongue that looks like a strawberry, experts say. .
What is invasive group A streptococcus?
Allison McGeer, an infectious disease specialist and microbiologist at Sinai Health System in Toronto, said bacteria, including Strep A, become “invasive” when they enter “wherever they get” it’s in your body that normally don’t have bacteria.”
That includes blood, muscle, and tissue. When Strep A enters those places, it causes serious illnesses such as necrotizing fasciitis (commonly known as flesh-eating disease), streptococcal toxic shock syndrome, and sepsis.
Invasive Strep A can also cause “really serious pneumonia” with “pulmonary pus,” which are pockets of pus around the lungs, says Kakkar.
Why are there more invasive Strep A infections now?
The World Health Organization said in a press release in early December that the increase in invasive streptococcal A infections could be linked to an increase in RSV and influenza viruses that attack children.
Experts say there are several possible reasons for that.
One is that common Strep A infections are increasing after a hiatus due to public health measures taken during the COVID-19 pandemic – and co-infection can lead to complications, McGeer said. .
“The combination of having more flu and having more group A streptococcus makes both the flu more severe and the group A strep infections more serious,” she says.
Viruses like the flu can also make it easier for already-existing Strep A to invade because they disrupt mucous membranes, McGeer said.
“(That’s) what viral infections do, right? They destroy the surface cells of your nose and throat ΓÇª and that of course allows bacteria to get in,” she said.
Kakkar says that’s what she sees in her patients.
“I think what is happening anecdotally is that many of my patients have the flu and then a week later they have a severe infection with group A strep,” she said.
The WHO says another virus associated with invasive strep A infections is chickenpox.
That could be in the form of necrotizing fasciitis, Kakkar says.
“When the skin is broken from chickenpox, strep bacteria can get in very easily.” she speaks.
Chickenpox in Montreal hasn’t spiked, Kakkar said, so it’s not currently one of the causes of invasive strep A infections there.
How is a Strep A infection treated?
Kakkar says antibiotics are usually given, but it’s important to be as sure as possible that the infection is indeed caused by strep.
If a child has a sore throat, it’s likely to be caused by a virus, not bacteria – so doctors will test to rule it out and determine if it’s strep throat.
“If children are prescribed antibiotics for any infection, it is important that they complete the full course even if they feel better than before,” she said.
There is a shortage of amoxicillin for children in Canada. What should caregivers do if antibiotics are needed?
Kakkar said liquid amoxicillin – a type of penicillin – is often prescribed to children because it is well tolerated. But there are a number of other options, from pharmacists crushing pills 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 not usually needed for strep throat because it resolves on its own.
But if antibiotics are needed, a different type of penicillin can be used, the association of pharmacists said. If the child is allergic to penicillin, other possibilities include cephalexin, cefadroxil, clindamycin, clarithromycin, and azithromycin.
How can we protect our children against invasive Strep A?
Doctors stress that it is still very rare for a Strep A infection to become invasive and cause life-threatening illness.
Doctors say Strep A is easily spread through close contact, as well as through sharing objects such as utensils or toys that children have saliva on.
They say that to protect against a Strep A infection, many of the same precautions are used against COVID-19, flu, and RSV, including frequent hand washing and staying home when sick.
Both McGeer and Kakkar say that another important way to protect against a serious strep A infection is to protect against the flu with a flu shot.
“I don’t think I’ve ever felt as strongly about it as this year. I’ve just seen a lot of complications in the hospital over the past few weeks and that’s unfortunate.” Kakar said.
“I strongly urge people to vaccinate their children because that is the way to prevent these serious secondary complications,” she said.
This report by The Canadian Press was first published on December 20, 2022.
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