Invasive Strep A: Doctors share advice for caregivers

The recent deaths of six children in Ontario and four children in British Columbia from a bacterial infection is grabbing parents’ attention. Doctors say severe cases of invasive Group A streptococcal infection are extremely rare. Here’s what to know about the disease that is showing up in record numbers this season and also puts adults, especially those aged 65 and older, at risk.

What is Group A streptococcus?

Streptococci bacteria are commonly found in the throat and on skin. Dr. Monika Naus, medical director of immunization programs and vaccine preventable diseases at the BC Centre for Disease Control, said some people have no symptoms but others may get strep throat, a mild illness often accompanied by a fever. It resolves on its own within a few days or is treated with antibiotics. A sore throat, on the other hand, usually comes with a cough, runny nose or other cold-like symptoms.

How does someone get infected with invasive Group A streptococcal infection, or iGAS?

The illness becomes invasive when bacteria enter the bloodstream or deep tissue, sometimes through an open wound or the nose and throat. It is passed on through direct contact with discharges from those membranes or with infected skin lesions, Naus said.

What are some ways to prevent infection?

Washing hands, especially before cooking or eating, is one protective measure, as is keeping any cuts or wounds clean and watching for redness or other signs of infection. Staying home when sick and getting vaccinated against influenza and COVID-19 is also important.

Naus said even a paper cut could lead to infection.

“I’m not meaning to scare anyone but it doesn’t have to be a serious trauma. Sometimes strep infections can be initiated by what’s called blunt trauma, which means the skin wasn’t even pierced. But the organisms were on the skin and entered the body that way.”

A viral infection, such as the flu, can allow Strep A bacteria to invade the body, making those infections more common in the winter months.

British Columbia has had 60 cases of the invasive illness in people under age 20 compared with thousands of cases of influenza and respiratory syncytial virus, or RSV, which is more likely to sicken young children and older adults.

What should parents be watching for?

“It’s a fine line trying to tell the difference between a child who’s miserable because they’re on their first or second day of a fever from the flu and a child who’s getting into trouble.” Naus said.

However, parents should be on the lookout for prolonged fever, difficulty breathing, sandpapery red rash or a swollen tongue, sometimes called strawberry tongue. A child who is groggy and has a tough time waking up should also raise concerns.

A child whose condition is deteriorating could also have pneumococcus disease, though children are vaccinated against it starting at two months.

While there is no vaccine for invasive Group A streptococcus, Naus urged parents to at least get their kids vaccinated against influenza and COVID-19.

“It can prevent those infections, and those infections can be a precursor to a more serious bacterial infection.”

Who is most at risk?

Dr. Upton Allen, head of infectious diseases at Toronto’s Hospital for Sick Children, said people with a weakened immune system are most susceptible to infection. In Ontario, children between five and nine have become ill, as have adults 65 and older, he said.

“Among adults, those with long-term illnesses such as cancer, diabetes, kidney disease and on special medications such as corticosteroids may be at higher risk,” Allen said. “Some of these infections may be mild but some may have severe outcomes.”

Families should be mindful that lesions sometimes caused by chickenpox may become infected and cause Step A infection, he said, urging parents to ensure their kids get routine vaccinations.

“Certainly, we have had concerns during the COVID period, and we all should advocate for there to be strong efforts to ensure that vaccines are up-to-date.”

What are severe but rare forms of Group A strep?

In very rare cases, Group A strep can cause necrotizing fasciitis, a flesh-eating disease; meningitis; cerebral spinal infection; toxic shock syndrome, which causes multi-organ failure; low blood pressure and kidney failure.

Naus said none of the four children who died in British Columbia were believed to have developed any of those conditions.

This report by The Canadian Press was first published Jan. 20, 2024.

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