Front Burner - Invasive strep A: what you need to know

Episode Date: January 24, 2024

Invasive Group A strep is a rare form of infection that happens when the usually harmless bacteria invades parts of the body where it's not normally found. This can lead to complications like flesh-eating disease, meningitis and even death — and case numbers are on the rise in Canada, with 10 children dead of the disease since October. CBC health reporter Lauren Pelley breaks down what you need to know about invasive strep A and the multiple factors that could be behind the recent surge in cases. For transcripts of Front Burner, please visit: https://www.cbc.ca/radio/frontburner/transcripts Transcripts of each episode will be made available by the next workday.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hi, I'm Damon Farrellis. So it's winter, which means it's peak respiratory illness season here in Canada. But this year, there's been a surge of another disease, invasive group A strep. It's a serious complication that can arise from a more run-of-the-mill strep infection.

And it can be deadly. So Quinn was five. Her name was Quintessence Henderson. She was Quinn to everybody. We didn't find out until later that it was Group A strep. 11 a.m. we arrived at the hospital. 11 p.m., she was gone. That's Christina Hectus. Her daughter Quinn died of invasive strep A last March.

In the last few months, six children have died of the disease in Ontario, and four children have died of it in BC. Those deaths are part of a rise in cases that has health experts worried. So today I'm talking to Lauren Pelley. She's a reporter with CBC's Health Unit. She's been looking at the story for the last few weeks and she's going to break it down for us. Hey Lauren, thanks so much for coming on Frontburner. Thanks for having me. So I don't know what things are like in your house, but I've got a child at home.

And this season, you know, we've been dealing with this trifecta of disease, flu, COVID, RSV. I can't tell you how many times my daughter's been home from school over the past few minutes. So when I heard about Strep A, you know, kind of making an appearance like this on the scene, it was definitely something that worried me. And I wasn't really sure how to, you know, how to interpret it. So I guess maybe just to start, you can briefly explain what is invasive group A Strep and we can break it down after that. Yeah, I mean, Strep is something really familiar to us. So there's no new strain of it. It's a common bacteria. It's often harmless.

A lot of times you can be carrying it on your body and you don't even know, like you might not even have symptoms. I mean, people can spread it pretty easily through close contact, like someone coughing near you, even sneezing or talking, or if you touch an open wound that might be infected with this type of bacteria. And in some cases, it does cause milder illness. So I think everyone's pretty familiar with strep throat. That's caused by this type of bacteria, scarlet fever as well. And those are usually treated with antibiotics. So what's different about invasive group A strep is not that it's something new on the scene. It's very familiar to clinicians. But it just means that this bacterial infection is happening in a place where this bacteria usually shouldn't be, right?

So it's more invasive. It's in your bloodstream or your soft tissue. or your soft tissue. And that can lead to really devastating disease, flesh eating disease, toxic shock syndrome, sepsis, organ failure, even death. So essentially, you know, if it gets into those parts of the body, like through a cut, even things like that, it can spread really, really rapidly. And that's sort of the terrifying thing about these invasive infections. Most strep infections never get to this point. It's actually fairly rare. But if it does, then, you know, within less than a day, people can take a turn. It can spread really quickly, really painful. Someone can go from awake and talking and walking around to being deathly ill. And that's what makes it sort of tough to identify, to treat quickly,

because the early symptoms can be so subtle and nonspecific, and then people can take this dramatic turn so fast. So you've talked to one mom in particular whose kid died of this Strep A infection. Can you tell me what happened there? Yeah, that was a tough interview. Really, really devastating for this family, an Ontario family. This mother's daughter was sick. She was five years old. And it was really sort of, you know, mild illness at first. You know, for any parent, it could have been anything. The kid had a fever. She felt unwell. Thursday, we noticed she started to have a fever. You know, we did the things every parent does, the Tylenol, the Advil, you know, trying to keep it down. And it did. It brought it down. So, you know, as our doctor had suggested,

to keep an eye on it. And if it wasn't coming down or if it had been longer than three days to, you know, go on to next steps. And the mom was talking to doctors and just trying to monitor her child at home. The symptoms were, you know, really nonspecific. Hard to know what was making her kid sick at that point. Things started to take a turn. You know, mothers go with their gut. And in this case, she decided to take her child to hospital. Saturday comes along. Her breathing is labored. Her fever, nothing's happened with her

fever. It's been three days. I said, OK, that's it. No more. We're going to the hospital. Even then, you know, they helped the child get hydrated and she was talking to nurses and seemed OK. And then things started to go further and further downhill. We find out through the x-rays that she has pneumonia and she had quite a bunch of buildup of pus in her lung. They ended up suggesting that we send her to McMaster for the PDU just to make sure that she could get the best care possible. One of the things that shocked the mother that she relayed to me

was just the speed at which all of a sudden her daughter started to crash and she ended up passing away in a matter of hours. I could not believe how quickly it can happen. believe how quickly it can happen. And I don't know how to tell other people how fast it was. My daughter was sitting, watching a movie, having a conversation with her nurses, and not six hours later, she was gone. I've heard from some doctors saying there's a real feeling of helplessness, that they don't always have tools once invasive strep has really taken a hold of a patient. I mean, we treat strep with antibiotics. Why is it so difficult to treat when it gets to that stage? Yeah, it's like any sort of really severe infection, right? I mean, antibiotics are a

common treatment for things like strep throat. But once this invasive strep starts to play out, you know, it's really deep into the tissues and the bloodstream and it progresses so rapidly. I think that's kind of what I want to leave people with more than anything. It's just the speed at which these infections progress, right? We're talking hours. So when you think of, you know, being in a hospital and you're having tests done and they're trying to figure out the best way to treat something, sometimes this disease just progresses faster than doctors can even figure it out. We're seeing this huge surge in cases this year of this invasive strep A. So I'm just wondering where it came from. Like if you're saying it's around us all the time, but now we've seen this new proliferation

of this, what's happening here? So I can tell you a bit about just the numbers for starters. I mean, we've hit this grim new record in Canada. So in 2023, all of last year, there were more than 4,600 cases confirmed at Canada's National Microbiology Lab in Winnipeg. That was an increase of more than 40% over the previous yearly high in 2019. So really, you know, we've seen quite a spike. And that's just what we know about, right? So here in Canada, invasive strep is reportable.

We collect that data. invasive strep is reportable. We collect that data. We don't really have a handle on exactly how much strep bacteria causing milder illness or no symptoms at all is circulating at any given time. But we do know these serious infections, right? We have a better sense of that. So, you know, different provinces have also shared data with us. Public Health Ontario tallied up 48 deaths from October to December last year. Six of those were kids aged nine or younger. In BC, health authorities have warned that strep A is on the rise there. Four children died since mid-December. The province is really seeing unusually high levels of the disease this winter.

So essentially, we're seeing a very similar trend in just different parts of Canada, So essentially, we're seeing a very similar trend in just different parts of Canada, rising rates of strep A in a record-breaking year for this invasive form of disease. So to your question about why, I think it's a really good thing to think of this in terms of two chapters, pre-pandemic and post-pandemic, right? So before 2020, scientists in Canada were tracking these invasive strep rates, and they were starting to notice a trend even then. More and more cases were being reported across Canada. One paper I saw said that the incidence rose from four to roughly eight cases for 100,000 people between 2009 and 2019. So in other words, the rate doubled in just a decade. That's not super common. It's still quite rare, but we're seeing a doubling, right? So why this is happening, scientists have a few theories. It could be partly because clinicians

are getting better at figuring this out. They're identifying more of these infections. But that wouldn't necessarily explain like why we've seen such a spike over the last, you know, 10, 15 years. It could be global travel playing a role. Other doctors think maybe it's more people living in congregate settings like long-term care, homeless shelters, more intravenous drug use, different settings where this type of bacteria is just more likely to spread. But it's probably not any specific factor. No one knows for sure, and there's likely not one smoking gun, as for why we saw that rise before the pandemic. And then there's the pandemic itself.

And I think that's a whole other ballgame as well of what happened after 2020. What do you mean? How does that come in? Well, doctors think that the impact of the COVID-19 pandemic is a bit more clear. So on one hand, you had all these people who didn't get the usual exposure to a variety of pathogens, whether that's viruses or bacteria like strep A. Thanks to all those restrictions, social distancing, all that stuff, I think we all really remember well. So people lacked immunity to some of those pathogens like strep. And then over the last couple of years, tons of people got hit at once. So particularly children who might really have never been exposed yet. So scientists think that is a factor coupled with all these different respiratory viruses rushing back, plus COVID-19 in the mix. So, you know that feeling you were saying earlier in your house, right? It feels like everyone's getting sick with something all the time.

You might be wondering, like, what does that have to do with strep? It can leave you vulnerable, right? If people are getting all these viral infections and your immune system is busy fending off one threat, and if you get a bacterial infection on top of that, two is worse than one. So scientists are like, that could also be playing a role. We don't entirely know for sure all these factors, but there's probably some combination of all this going on. I'm going to go. Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not

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They had a really big outbreak of invasive strep A last year, last season, I should say. So there was more than 500 deaths during that outbreak. 60 of those were kids. And to put that in comparison, like usually only a couple of children die in the UK each strep season. And they had 60, right? The death rate in that whole outbreak was nearly 14%. Wow. And how does that, the death rate compare with the normal death rate? When it becomes invasive, the death rate is thought to be quite high. So a lot of the estimates I've seen are around 10%. So one in 10 people passing away from invasive strep A infection, which is quite high.

quite high. I guess, you know, whenever children are dying from any disease, it's incredibly alarming to hear about. But I think just that I just want to kind of put it in perspective. And I think the question that I had when I first heard about this is like, what are the experts, what are the health experts saying about it? How concerned are they about this situation? Is this something to be alarmed about or is it just something to keep an eye on? Yeah, I mean, the physicians that I've spoken to are concerned. I don't want to downplay that at all. No one says, you know, there should be public panic. This is still rare. And even if your kid gets strep throat, the chance of them having this turn into an invasive, deadly form of strep is still small. But, you know, because it spreads in someone's body so quickly, once it takes that

turn, you know, people really need to be aware of what to watch for. And physicians are worried. They say, we need to be tracking this. We need to be looking at these trends and figuring out how to mitigate this, because the fewer people who get these types of invasive infections, the better. I mean, it is such a deadly thing. We've been talking about like the acute symptoms here. Obviously, you know, when it gets deadly, it's really terrifying. But it can also just, you know, it can be like a long recuperation. But there's also like long-term consequences if you get over strep.

So what have you found out about that? Yeah, so invasive strep, again, you know, there is a high death rate. But what happens to the other 90% of people who survive? I mean, if you have any of these serious conditions that an invasive strep infection causes, so brain inflammation, flesh-eating disease, you can have, you know, neurological damage, which can lead to lasting impacts. Another thing I should note is if you survive flesh-eating disease, sometimes that can lead to amputations and really, really serious ramifications.

So have public health officials taken any sort of measures yet, or is there any talk of that? So we've spoken to different provinces. We've spoken to the Public Health Agency of Canada. And we know that different regions are obviously tracking this. Like, this is a nationally reportable infection. And we've seen notices sent out to doctors and whatnot, trying to make them aware that there has been this spike in invasive group A strep. So, you know, the sense I get is a big part of this is data collection. We're really seeing this effort to track more of this, to get a sense of how many cases are appearing over time. But the data is messy.

Like we don't collect that information on mild or strep. We don't have a database. So we're sort of missing that bigger picture. And even for the really serious infections, the federal data doesn't include what actually happens to those patients. So we don't know, you know, of the people getting invasive group A strep, how many are hospitalized, how many are dying out of that patient population, like what each person goes through isn't entirely clear. So again, I think this raises questions of, you know, how much more should we be doing to track this to inform the public?

Again, this is something that's rare still overall, but the rates are rising. So where do we go from here? I think that is a conversation that governments and doctors are having right now. You mentioned there's a lot of questions out there. It's not, we don't have a full picture yet, a lot of data to be collected. But in terms of like the takeaway, when you've got kids at home you're worried about, loved ones you're worried about, what should we be doing to protect ourselves? Well, I think it's really knowing the warning signs of invasive strep A. really knowing the warning signs of invasive strep A. And unfortunately, it's one of those tricky infections, as I said, because the early symptoms can be so subtle and nonspecific and just,

you know, like any mild infection, right? You can have a fever, you can feel a bit unwell, and that doesn't mean it's invasive group A strep. It could be a bunch of different things. But I really would encourage people to go with their gut when you know that you're really feeling unwell or you're seeing those changes in your child. So some of the warning signs to watch for that signal that something could be going seriously wrong and there may be an invasive strep infection spreading in someone's body, it kind of depends on which condition it's sparking. But if we're talking about flesh eating disease, that can lead to really severe pain and redness that can start to spread really, really quickly. If we're looking at meningitis, so brain inflammation, someone might have a headache, a stiff neck, sensitivity to light. They might be confused or throwing up. And when it's leading to organ damage, toxic shock, someone might have confusion, pain.

They might feel really dizzy and feverish and deeply, deeply unwell. Any of those are warning signs that you need to get to a hospital. You need to seek medical attention for you or your child or your loved one. The one thing you can do to actually prevent this is get vaccines for other things. So we know that some of the deaths that have occurred in British Columbia, for instance, were confirmed co-infections where children had influenza and strep A or another viral infection and strep A. So we can't vaccinate anyone for strep A right now, but there are vaccines available for influenza and COVID.

You know, we're hearing a lot about how overloaded the health care system is, right? And I guess I'm curious, does that come into play? Like, are people not seeking out health care when they should, or are there longer waits, or any factors like that? Yeah, there has been, you know, obviously public health officials in recent weeks who've said, please stay away from emergency rooms. They're so busy. They're so full. But this is one of those times where if someone has these warning signs, you go, right? You know, obviously, our health care system is pretty stretched thin right now. But again, I would say you just got to go with your gut.

And this is the same advice I've heard from so many different doctors is, yes, things are busy. Yes, they're overwhelmed. But these are really serious, fast-spreading infections. Yeah, I mean, it's a tough time in Canadian health care, but this is one thing you do not want to mess with. All right, Lauren, thanks so much for coming on. I really appreciate it. Thank you. All right, that's it for today.

I'm Damon Fairless. Thanks for listening to FrontBurner. I'll talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.