As the United Kingdom grapples with the deaths of children caused by invasive strep A, the situation in Canada seems much more in control, experts say.
In an email sent to Global News, the Public Health Agency of Canada (PHAC) said invasive streptococcal disease or iGAS is not a threat to Canadians “at this time.”
In Britain, however, cases of scarlet fever cases caused by group A streptococci continue to remain higher than what is usually seen at this time of year, the U.K. Health Security Agency (UKHSA) said in its latest statement.
The statement released on Dec. 2 says there have been five recorded deaths, but according to the BBC article published on Dec. 6, “seven children in England and one in Wales have died due to complications from strep A bacterial infections since September.”
“The U.K. cluster does not pose an increasing risk of invasive streptococcal (iGAS) disease,” PHAC said.
“Information on mild cases of group A streptococcal infection, such as those with sore throat or scarlet fever, is not collected by the Public Health Agency of Canada,” it said, adding “only iGAS disease is nationally notifiable.”
“iGAS disease is endemic in Canada with 2,000-3,000 cases annually in recent years,” the agency said.
What is Strep A?
According to the U.S. Centers for Disease Control and Prevention (CDC), Strep A (short for group A streptococcus) are bacteria that can cause many different infections ranging from minor illnesses like scarlet fever to very serious and deadly diseases like pneumonia.
The government of Canada website also says that most illnesses caused by group A are mild and may include strep throat, sinus infections, skin or wound infections, or fever and rash (scarlet fever).
“It’s a common bacterial infection … but it can cause what’s called an invasive group A strep infection, meaning the bacteria is in the blood, And, a very life-threatening skin and soft tissue infection (is) much rarer, but of course, it can happen,” Dr. Isaac Bogoch, an infectious diseases specialist at the Toronto General Hospital, told Global News.
“We see (cases of group A strep) after a viral illness. There’s a bump in cases of group A streptococcus after that, including after illnesses such as pneumonia and influenza A, so it’s not unknown to the medical community,” Bogoch said.
“It’s a huge spectrum of illness,” Dr. Earl Rubin, director of the infectious disease division of the Montreal Children’s Hospital, told Global News.
A streptococcus infection is common among children and adults, and it was only considered serious in the pre-antibiotic era, according to Rubin.
“Now it’s generally not serious, but we want to treat it to prevent ongoing transmission and to prevent complications,” he said.
Can strep A be dangerous?
According to the government of Canada website, in rare cases, a group A strep (GAS) infection can lead to invasive, more severe disease. This is known as invasive GAS or invasive streptococcal (iGAS) disease.
Severe cases include “lung infections, such as pneumonia, flesh-eating disease (necrotizing fasciitis), which is a quickly progressing infection that destroys skin and muscle tissues, or toxic shock syndrome, which occurs when the bacteria produce toxins that could cause organs in the body to stop functioning.”
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“In the early 80s, we were seeing more of this invasive, serious illness, and it was related to certain groups or types of strep that had persisted,” said Rubin.
“We see cases periodically, but not generally in an outbreak setting,” he added.
He said deaths associated with group A strep would either be caused by a toxic shock syndrome, flesh-eating disease, or invasive group A strep.
The government website states invasive group A strep develops when the bacteria enter parts of the body where bacteria are not normally found, such as blood, muscles, or bones and joints.
How does Strep A spread?
The (CDC) says group A strep bacteria “spreads through contact with droplets from an infected person when they talk, cough, or sneeze.”
“If you touch your mouth, nose, or eyes after touching something that has these droplets on it, you may become ill.”
Bogoch says the infections are more commonly found in impoverished situations where overcrowding and hygiene facilities for hand and body washing are limited.
Treatment for Strep A
Both Bogoch and Rubin agree that penicillin or amoxicillin are the antibiotics of choice to treat group A streptococcus.
“The treatment is actually remarkably straightforward … so this is a bacterial entity that’s well known to people who practice clinical medicine, including family physicians, emergency physicians and infectious disease specialists,” Bogoch said.
“That’s something that we see on a fairly regular basis. But luckily, the more severe cases are rather rare,” he added.
Who are at an increased risk?
According to the CDC, group A strep “is most common in children 5 through 15 years old. It is rare in children younger than 3 years old.”
However, adults can get it too.
The CDC says adults who are at increased risk for scarlet fever include parents of school-aged children and adults who are often in contact with children.
“Close contact with another person with scarlet fever is the most common risk factor for illness. For example, if someone has scarlet fever, the bacteria often spread to other people in their household,” the CDC said.
Normally, crowded settings can increase the risk of getting a group A strep infection, according to the CDC. These settings include schools, daycare centers and military training facilities.
How to stay safe?
The spread of all types of group A streptococcal (GAS) bacteria can be reduced by good handwashing, especially after coughing and sneezing, according to PHAC.
“Proper hand hygiene helps reduce the spread of all types of group A streptococcal disease, especially: before eating, before preparing food, and after coughing and sneezing,” the agency said.
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To help protect others, PHAC recommends individuals “practice proper respiratory etiquette by sneezing and coughing into a tissue or the bend of their arm and cleaning and disinfecting frequently touched surfaces and objects.”
PHAC also states that individuals experiencing symptoms should quickly seek medical attention. It’s a recommendation Rubin echoes.
“If a child is so unwell that they are not eating, not drinking, and they are just so lethargic and out of it, they have to go to emergency,” said Rubin.
“There’s nothing to tell parents other than if the kid is so sick, they have to come in, but if they just have a sore throat or fever then it’s best to see a health-care provider,” he added.