In the midst of the respiratory virus season in Canada, government data shows strep A cases have been on the rise in the past year, with invasive disease resulting in hospitalizations and some deaths among children.
“Early data indicates that iGAS disease activity in 2023 is higher compared to pre-pandemic years, particularly in children under 15 years of age,” the Public Health Agency of Canada (PHAC) told Global News in an emailed statement.
Invasive group A streptococcus (iGAS) has been identified collectively by the federal, provincial and territorial governments as a priority for monitoring and control and must be reported to the public health authorities, PHAC said.
iGAS occurs when the bacteria cause deeper infections and are isolated from a normally sterile body site, such as the blood, the agency said.
Respiratory viruses like influenza, COVID-19 and respiratory syncytial virus (RSV) can raise the likelihood of getting sick with strep A, said Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre.
Strep A are bacteria found on the skin and throat that can cause a wide range of diseases in children and adults. Infection occurs from direct contact with infected skin wounds or respiratory fluids when an infected person coughs or sneezes.
“When your body is fighting off one of these viral infections, it’s possible to get a second infection on top of that because of your temporarily weakened immune system,” Conway told Global News in an interview.
According to PHAC, iGAS is endemic in Canada, with 2,000 to 3000 cases being reported annually in recent years.
“I don’t think the concern is much different from what it was last year and the year before,” said Dr. Dominik Mertz, division director of infectious diseases at McMaster University. “The invasive strep A infections remain rare, but we certainly see a trend towards increasing cases,” he told Global News in an interview.
Where are strep A cases rising?
Health authorities in British Columbia recently warned that the province is seeing “higher levels” of invasive group A streptococcal (iGAS) infections than historical averages, especially among children.
A joint statement from the Provincial Health Services Authority, the BC Centre for Disease Control and BC Children’s Hospital on Dec. 22 said there were 51 cases of group A streptococcal infections last year among people under the age of 20.
That is more than twice the number forecasted by health officials, with only 20 cases in 2022.
Last month, a four-year-old girl in Winnipeg died after battling an invasive group A streptococcal infection, according to a GoFundMe page created to raise funds for the family.
A spokesperson for the Manitoba government told Global News the number of lab-confirmed and probable iGAS cases rose from 114 in 2021 to 200 cases in 2023 — an increase of 75 per cent.
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Seventeen of the cases in Manitoba last year were fatal, with three of the deaths occurring in patients who were younger than 20 years of age.
Alberta has also seen an increase in group A streptococcal (GAS) and invasive group A streptococcal (iGAS) infections, according to an Alberta Health spokesperson.
A total of 739 confirmed iGAS cases, the majority in adults, were reported to Alberta Health last year, the spokesperson said. This represented a 41 per cent jump from 2022 when 434 iGAS cases were reported.
Invasive group A strep infections, mainly in adults, have increased in Prince Edward Island, Dr. Heather Morrison, P.E.I.’s chief public health officer, told Global News in an email.
A total of 28 iGAS cases were reported in 2023, compared to the usual number of 0 to 11 per year.
In Nova Scotia, the rates of invasive group A streptococcal disease (iGAS) have increased among all age groups since 2022.
Khalehla Perrault, a spokesperson for N.S Department of Health and Wellness, told Global News that 94 iGAS cases were reported in 2023, with the highest rates occurring among the oldest and youngest populations.
The rates in 2023 were also higher than the previous five years, she said.
In Ontario, 303 invasive strep A cases were reported between Oct. 1 and Nov. 30, 2023, according to the most recent provincial data released Dec. 14.
Over that time period, 13 children between the age of one and four years and nine between five to 12 years were hospitalized for iGAS. Three people below the age of 18 also died.
Case counts decreased in November compared to October, but were higher than the same time the previous year, the report from Public Health Ontario said.
Global News reached out to all the provinces, but didn’t hear back from the others by the time of publication.
What are the symptoms of strep A?
Group A streptococcus is a bacteria that can cause a wide range of diseases in people of all ages.
Most illnesses are mild, presenting symptoms such as fever, sore and painful throat, skin rash, sores, bumps and blisters in non-invasive infection, according to PHAC.
Strep throat, or pharyngitis, is “much more common” in children than adults, said Dr. Earl Rubin, division director for pediatric infectious diseases at the Montreal Children’s Hospital.
Given the overlapping symptoms with a respiratory viral infection, for strep A, parents should be on look out for a sore throat with fever that is not associated with a new runny nose, blocked nose or cough, he said.
“If somebody has at the same time a sore throat, fever, all the other symptoms of a cold that started within a day or two, that is not strep and that’s viral.”
Skin infections from GAS can be benign, resulting in crusting and oozing, but generally the child or adult is “not that sick with it,” Rubin added.
In rare cases of invasive infection, patients can experience severe symptoms like pneumonia and toxic shock syndrome, which can cause an unsafe drop in blood pressure, vomiting and diarrhea.
Rubin said the most severe illness from invasive group A strep is necrotizing fasciitis or flesh-eating disease – a condition that breaks down skin and muscle tissues.
All forms of invasive disease “will be very evident to parents” and they should seek medical attention for them.
People who have breaks in skin, such as cuts, chicken pox or burns, those suffering a chronic disease or who have a weakened immune system are at a higher risk of strep A infection, according to PHAC.
Prevention and treatment
Strep A bacteria can easily spread within a household or in other closed settings such as classrooms or daycare.
“Those who spread it may not necessarily be symptomatic because you can just be a carrier of the bacteria,” Mertz said.
There is no vaccine available for strep A, but it’s important to get vaccinated for respiratory viruses, like COVID-19 and influenza “to limit the likelihood of a serious infection,” Conway said.
Experts recommend practicing good hand hygiene by handwashing or using hand sanitizers.
Antibiotics are an effective treatment to treat strep A – both invasive and non-invasive.
Strep A is “uniformly 100 per cent sensitive to penicillin,” Rubin said, so it can very easily treat the infection.
For those who are allergic to penicillin, there are many alternatives and group A strep is “sensitive to all of them”.
If you have been diagnosed with GAS, PHAC advises to stay home for 24 hours after starting antibiotics to prevent others from getting sick.
Rubin said a person is no longer infectious to others typically 18 hours after antibiotics treatment.
If a child experiences shortness of breath, progressive lethargy or has a high fever that doesn’t get better with acetaminophen, a health care provider should be consulted, Conway said.
Is strep A seasonal?
Strep A infections can occur throughout the year with upticks and decreases over time, Rubin said.
At this time of the year, an increase in incidence of easily transmissible infections, such a group A strep, is typically expected, he told Global News in an interview.
Conway said strep A can be a “serious secondary infection” on top of a respiratory virus that does itself have a season – and Canada is right in the middle of that now.
Prior to the COVID-19 pandemic, there was “some level of seasonality” with strep A but not at the same level as seen with respiratory illnesses, like influenza, Mertz said, referring to Ontario data.
“It’s very hard to predict what’s going to happen in the next few months, whether we see an increase as we would have seen in the past going into the spring months or whether given that we’ve seen more last summer, we may not see the same level of seasonality now,” he said.
— with files from Global News’ Katherine Ward and Sean Boynton, and The Canadian Press
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