The Decibel - Invasive Group A Strep infections: what you need to know

Episode Date: January 23, 2024

Cases of Invasive Group A Strep infections are on the rise in Canada. It’s an illness with potentially fatal outcomes – four children under 10 have died in British Columbia since mid-December, and six people under the age of 18 died in Ontario in the last three months of 2023.Carly Weeks is a health reporter for the Globe. She’s on the show to talk about how to recognize Invasive Group A Strep infections and why experts believe they’re on the rise.Questions? Comments? Ideas? Email us at [e-mail]

This time of year, respiratory viruses are everywhere. But there's also another infection that's on the rise. Invasive Group A strep. These past few months, there's been an increase of severe strep infections in Canada, sometimes leading to very serious illness and even death. So The Globe's health reporter, Carly Weeks, is back on the show today to explain the risks and what experts think is behind this rise of invasive Group A strep. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail.

Carly, thanks so much for being here again. Oh, of course. Good to be here. From the Globe and Mail. respiratory viruses. Today, we're going to talk about invasive group A strep. So Carly, what exactly is invasive group A strep and what causes it? Yeah, this is actually a really common type of bacteria that we find, you know, all over the place. I think everyone's pretty much familiar with strep throat. So this is the kind of bacteria that we see often and people can even be carrying around without realizing it. There's other bacteria that we, you know, kind of interact with on a daily basis that can be harmful in some instances, but you know, in some people doesn't cause symptoms or only under the right circumstances does it cause symptoms. So this is a bacteria. The problem is that if it becomes introduced into a person's throat or is through their skin via a cut, this is where it can start to cause problems. And in some cases it can start to be invasive. So I think it's important to separate out that

group A strep can cause things like strep throat that most people will recover from and other mild infections like skin infections. These are the kinds of things people will recover with. They may need antibiotics, say, to recover from a very painful strep throat. But this does not mean it's going to turn into an invasive group A strep infection. But if that strep bacteria travels further into the person's system, so gets into their bloodstream or gets into their deep tissue, this is where the problems can begin. So essentially, you know, this can really start to do a lot of harm in a person's organs and a person's brain, depending on sort of where the bacteria end up. So public health officials have said they're watching this rise in invasive group A strep cases. Why are we hearing so much about this now? So this is really concerning. These

invasive strep A infections are quite serious. They can be fatal. The reason we're hearing so much about this now is that even though these infections have been around forever, this is not brand new, we're seeing a somewhat alarming uptick in cases, particularly in kids. We know that seniors are often at risk for these types of invasive infections, people whose immune systems are compromised. But right now, for perhaps a number of reasons, we're seeing infections in kids on the rise in a pretty significant way. And can you give us a sense of, I guess, the numbers? Like, how does this season compare to previous seasons? Yeah, I mean, BC officials came out with an update at the end of last week. So they said that in 2023, they had triple the number of infections in young people than they had the previous year. So basically three times as many. So that is quite an anomaly and obviously, you know, cause for concern, right? I mean, I don't think anyone's trying to alarm the public. And certainly these infections remain

somewhat rare. But in BC alone, there have been four deaths in children since mid-December. So obviously, you know, when this does strike, it can be very serious, it moves quickly. And health officials want people to be aware of the fact that this is happening. And when we say, talk about like the seriousness of it, do we have a sense of like hospitalizations or how many people are affected seriously by this? Sure. Yeah, definitely. I mean, and all of these numbers are tracked by various provinces and the federal government. So we know that more people overall are getting infected. Kids in particular, those rates are going up. And of people who get infected, sort of, it can vary by age group and sort of, you know,

the severity of these infections. But in general, you know, the majority of people, let's say 75 percent or perhaps even more of people who get infected will require admission to hospital. 75 percent of people are infected. Wow. Yes. Just underscoring right how serious this really is. And when you look at sort of things like, you know, fatal outcomes, estimates can vary, again, depending on each group, but anywhere from, say, 5% to 15% of cases will end up being fatal. So obviously a very, very concerning trend, especially when you see this happening

in young people. Yeah. And you mentioned some numbers out of BC. It sounds like we're also seeing this, though, in other provinces across the country as well. That's right. Yeah. So we had Public Health Ontario, for instance, reported that they had a very big increase so that from October to the end of December, they had 540 cases in the province across all age groups. And that is including six deaths in people under age 18, 60 cases in people in BC under age 20 last year. That's again, three times the amount they would expect. Other provinces have reported similar trends, New Brunswick, Quebec, I believe Manitoba as well. And I think if you probably asked officials in every single province, which we often have to sort of do not having a national system, you see these trends being reported across the board. What are the symptoms typically if someone is infected?

Symptoms of an invasive group A strep infection will not look typically like, you know, sort of your regular cold or flu, right? Like a child who's coughing or sneezing. So some of the symptoms to be very watchful of and to seek action on sort of in an immediate way, don't wait and see. Things like a fever that does not relent. So five days of fever, that's cause for concern. And I think most parents would be aware that that's kind of a bit unusual, right? The child who has a very long lasting fever coupled with a rash that sort of feels like really rough sandpaper on the skin. The skin may be very red. Sometimes there's a swollen tongue involved. A kid who's lethargic, so a child that's difficult to wake, a child who's very sleepy, any sign of difficulty breathing,

a child who's experiencing a lot of pain. And a lot of these symptoms would go for other age groups as well. But I think in kids, you have to often do a lot of guesswork and And you have to, as the parent or caregiver, identify when there's something going on here. You know, and I think a lot of times, according to the doctors that I spoke with, you know, it is kind of apparent that something is the matter. Like this is not, you know, give the child sort of a warm cloth and a show and a popsicle. This is okay, what's going on here. And they're saying in those instances, go and seek help. And even though emergency rooms are rather busy, this is not the time to sort of wait and see is the message. Okay. Okay. So yeah. So if these symptoms are presenting in a concerning way, this is what you're saying. It's something you should be taking seriously. And I understand

that invasive group A strep can also lead to a number of severe outcomes. Can we talk a little bit about that? What can actually happen with this infection? Yeah, definitely. Yeah, we refer to it sort of requiring hospital admission or being fatal. But really, that's because through a number of different illnesses that this can cause. So, you know, things like pneumonia, meningitis, very scary, obviously. And then the bacteria can also release toxins, so leading to toxic shock syndrome, and even in rare instances, flesh-eating disease. So very, very serious outcomes here that require immediate attention and intervention. Can we just dissect that for a second here, Carly? How does this bacteria develop to the point of a flesh-eating disease?

Right. So according to the experts that I've spoken to, a lot of this really depends on, you know, when the bacteria becomes invasive. So it gets into your bloodstream, it gets into your deep tissue that allows it to just kind of move around and do damage that in otherwise sterile areas of the body where it wouldn't be able to get to. So it really depends on where the bacteria kind of travels to and how it's able to impact, say, the tissue or different organs, the brain. And that's how it can become, essentially, in a very high-level way, this is how it's able to lead to these different kinds of outcomes.

Obviously, a lot of people will recover, most people will, but this can have devastating effects on an individual's health. So how does someone actually contract severe strep A? It's one of these things that it's difficult to predict. It can be difficult to sort of protect yourself because these bacteria are just around us all the time. So we mentioned that people can be sort of carriers and asymptomatic kind of having this bacteria in their throat. So what can happen apparently is that if that person, say, comes into contact with a respiratory virus like a flu virus, that can suddenly weaken their body's defenses. So say your throat tissue is rough and scratchy

from coughing, the bacteria is then able to gain a foothold and become invasive in that person. Similarly, you know, like we've heard with other kinds of, you know, respiratory viruses or issues, a person who has this bacteria can cough or sneeze or talk and pass it on to someone who's nearby. So if it lands, you know, on your skin and you have, you know, a little cut, it can get in that way. Or it can land, you know, near your respiratory tract, you know, so you're talking to someone or coughing, it lands, you know, in your nose or throat, and then the bacteria can get in that way. And again, under the right circumstances, can become invasive. Again, rare,

but it's happening. And do we know who's at the greatest risk of severe outcomes here? Yeah, if you look at the data, seniors often fare the worst. You know, I think that their sort of fatal outcomes are linked to invasive group A tend to be the highest. But in kids, it's not much far behind. So, you know, seniors, young kids, and then of course, people who are in any way immune compromised. So people who are dealing with a chronic illness, people who are living with cancer, people who are pregnant, there's so many different kinds of conditions that make people susceptible to these kinds of infections and others. We'll be back in a minute.

Okay, so Carly, we've talked about the symptoms, a bit about how invasive strep A can be spread. I guess the big question here, though, is why are we seeing such an increase in these more severe strep infections now? Yeah, this is, I think, the question that's been plaguing a lot of people who are working in this space. You know, why now? So there's probably a number of factors going on. Organizations like the World Health Organization are looking at this question and trying to figure out what's happening. I've spoken to a number of experts in Canada who believe that there is a strong tie to the fact that we're seeing more respiratory illnesses in children, and some of those illnesses are preventable. And that's because

invasive group A strep infections are much more common in people who are dealing with a respiratory virus. I think we've often heard of, you know, a person who develops an illness, and then they get a secondary bacterial infection. And these are exactly the kinds of situations that we're speaking about right now with invasive group A strep. So say a person is dealing with the flu, and then their body's defenses again are weakened, it's easier for the bacteria to get in and become invasive. And so the more people that are infected, the more chances there are for these bacteria to enter a greater number of individuals. And that's really the concern here is that, you know, as more and more children are sort of spreading these viruses

around, this may be one of the causes. There could be other things at play too. You know, we did have a couple of COVID years where we didn't have a lot of spread of viruses. And what we saw say last year, for instance, was that as people were getting back out and, you know, kids were in regular classrooms and daycares and people were spreading viruses again, traveling and everything else, we saw a huge upswing in viruses, kind of like a couple of quiet years followed by a bit of a rebound as kids who hadn't been exposed were getting sick maybe multiple times. But the unfortunate consequence is that we may as a result be seeing more of these invasive bacterial infections, which is obviously a huge concern, especially if we

consider that some of these viral infections are preventable. Okay, so it sounds like some experts are thinking because we're seeing this rise in respiratory viruses, this is also kind of causing this rise in severe strep A. You said, you know, a lot of these are preventable. So can we talk a little bit about that, Carly? How does that play into this? Yeah, certainly. So if a respiratory virus is, you know, kind of making a person more vulnerable to an infection, like a severe group A strep, then it would seem to make sense that you want to do everything you can to prevent those viruses from happening. So, you know, if you look at things like the common cold, we don't have vaccines for those. We likely never will. There's too many of them. And, you know, they tend to be very mild illnesses. But something like the flu is deadly. It can be deadly to kids, deadly to seniors and

people with compromised immune systems and others. Every year in Canada, there's deaths in kids from the flu. Yet the uptake of the flu vaccine is very low. It tends to be very, very low overall. Seniors have, you know, higher uptake of the flu vaccine, but kids have very low uptake, even though the outcomes can be quite severe. So when I'm speaking to experts about this, you know, one of the messages that they continuously try to send is that, you know, kids need the flu shot to protect them, not just from the flu, but from severe outcomes like this. And when you look at COVID, again, you know, COVID infections may be mild in most children, but it's another respiratory infection that you can help prevent and help prevent some of those more severe outcomes.

And other viruses that we are very common in childhood, but we don't yet have widely available vaccines for are RSV. That is a very common virus. So there's been some exciting developments there with vaccines now available or coming online soon, hopefully by next season, you know, for people who are pregnant so that they can protect their infants. And we're hoping to have more availability of vaccines there. But essentially, you know, staying home when you're sick, wearing masks in crowded places, handwashing, all of those things are needed. But, you know, vaccines will really help also prevent the spread of these preventable types of infections.

And I remember reading something about chickenpox, too, like kids who get chickenpox. Also, this can, again, increase your vulnerability to invasive strep A. Can you tell me about that? That's right. And I'm glad you mentioned that. So, you know, any type of virus, really, like measles, you name it, can increase your susceptibility to these invasive bacterial infections. But there's a special place for chickenpox. And because when you think about it, it makes sense. A person who is infected with chickenpox has so many different open sores on their bodies, which are all portals of entry for this type of bacteria. So kids who have chickenpox are much more likely to get invasive group A

infections than kids who do not have chickenpox. So there's a special need really to get that message out that kids need to be up to date on all of their vaccines, particularly chickenpox. Right now, there's no evidence that chickenpox is leading to this increased number of invasive group A infections. But we've seen that during the pandemic and even before, but especially during the pandemic, there was disruption to regular vaccine programs, problems with vaccine confidence on a whole. And so there are large concerns about the implications that this is going to have going forward. So, Carly, this is obviously an issue throughout Canada. Are we seeing an uptick in severe strep A in the U.S. or elsewhere in the world? Like are other countries also experiencing this? Yeah, this is a phenomenon that's impacting

many different countries. It was actually, you know, well over a year ago, the World Health Organization came out with a statement saying, you know, it's been watching this, it's been seeing reports from countries throughout Europe, you know, and sort of peer countries like the U.K. and France. That's not a whole lot of comfort, though, either, right, to see that this is happening around the world. So there's other theories being looked at, you know, is this a different type of bacteria that's, you know, emerging? Is there more evidence to suggest that there's something happening, particularly with kids? A lot of these questions really aren't answered fully yet. And I think that, you know, we know that respiratory virus season is playing

a huge role here. But overall, this is something we're going to be keeping a close eye on in the months and likely years ahead. I guess how have public health officials, let's talk about Canada specifically, how have they responded to this increase in severe strep A infections? I mean, we've heard from some jurisdictions, most recently BC, kind of issuing reports, alerting the public to a rise in infections and kind of warning caregivers about what to look out for. So some of those symptoms that we talked about a bit earlier, you know, asking people, advising people to go and seek help. You know, in some ways, we don't necessarily get a lot of proactive messaging on different types of viruses from every health official in the country. You know, there may be different reasons for that. And perhaps, you know, it's time to hear more on this, because I think this story has really alarmed parents, the fact that we're

hearing there's more of these infections happening. So I think it's likely a time for more health officials to be a bit proactive with some of their messaging on what parents need to do and what caregivers need to look for. This is what's known as sort of a reportable condition. So these infections do get tracked. This is not sort of something that just gets filed away like, oh, it's the flu. I mean, this is looked at closely. It's also important for, you know, family practitioners and other care providers around the country to be on the lookout, right, to have this top of mind. I mean, certainly they would have received training on this. But again, you know, in busy respiratory virus seasons with presentations or, you know, symptoms that may be a bit unusual, it's really important to have caregivers well aware of what's going on as well.

I'm just curious, you mentioned a reportable condition. Like, what does that mean? I guess, what's the distinction there? Yeah, so there's a whole range of different conditions that are considered reportable, which basically means someone is tracking it. So if you see a case of measles, for instance, that is something that is going to be recorded and tracked. So if, say, if a person shows up in an emergency room, has symptoms of measles, ends up being positive for measles, that ends up getting sort of reported. There's a whole system in place for health officials at a local level to report that into their various overseeing public health office.

And then that gets tracked provincially. It gets tracked by territories. It gets tracked nationally. And then all of those reports get looked at to try and figure out where these trends are going. Just before I let you go, Carly, I mean, this can obviously be really concerning for a lot of people who are worried about their kids or the seniors in their lives. So is there anything that people can do to protect themselves and their families from invasive severe strep A infections? You know, one of the challenges is that this is really impossible to predict who is going to get this, who is going to get severely ill as a result. Obviously, we know there's high risk groups.

So I think, you know, the advice from experts is take all of the precautions that you would in, you know, respiratory virus season. So that means handwashing, mask wearing, staying home when you're sick, keeping your kids home when they're sick. Of course, we need to have, you know, laws in place for people to be able to do so if they don't have sick days, right? So people need to have sick pay, they need to be able to stay home and not lose their jobs. So that, you know, it gets challenging when we think about it from that perspective, and stay up to date on all of your vaccines. And other than that, it is a very difficult thing to sort of say, well, it may happen anyway, right? These things are often very impossible to predict. We know that in households where people are impacted, or say, if you're living in a group

home type environment, if a person is infected with invasive group A strep, you're more at risk. So there's special steps that public health officials may take like proactive antibiotics for people in those households, in those networks. Carly, thank you so much for taking the time to be here today. Of course, it was my pleasure. That's it for today. I'm Maina Karaman-Wilms. Michal Stein produced this episode. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin.

David Crosby edits the show. Adrienne Chung is our senior producer. And Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.