Officials stumped by increase in strep
Invasive Group A infections the most since 1997, when it was mandatory to report the disease
Faced with surging numbers of severe, invasive Group A streptococcus infections across B.C., mystified provincial public health officials are seeking feedback from Canadian and American counterparts and preparing to publish reports to draw attention to the problem.
A soon-to-be-released report will show that in 2016 there were 303 confirmed cases of invasive Group A streptococcal disease (iGAS) in B.C. or 6.4 cases per 100,000 population, the highest rate since 1997 when it became a mandatory reportable disease. Illnesses like scarlet fever, strep throat and impetigo are caused by strep A bacteria — but so, too, are potentially deadly toxic shock syndrome and flesh-eating disease (necrotizing fasciitis). That is what an 11-year-old Richmond boy contracted four months ago when he was one of two boys in the same classroom who got iGAS.
John Chen has been in hospital since March. A classmate was hospitalized a week earlier with different complications from the infection.
It is the first time a cluster of cases has been reported to public health officials in Canada, so B.C. experts are now reviewing policies and consulting colleagues to determine whether notifications to parents should go out earlier than they did in this situation when families got letters only after the second case.
Dr. Monika Naus, a medical director at the B.C. Centre for Disease Control, said experts are unsure how to turn iGAS incidence trends around. In the Vancouver Coastal Health region, there were 47 cases of iGAS, according to the most recent (April) year-to-date report. That compares to 34 the year before. In 2016, there were 114 cases in VCH or 9.8 cases per 100,000 population. That is more than double the average of 47 cases for each of the preceding four years, when the rate was 4.2 per 100,000 population.
The highest number of cases (84) was in Vancouver; those affected ranged in age from five to 83.
Naus said she does not think the increase has anything to do with cases being miscategorized because lab confirmation is required. Experts have consulted addiction specialists since injection drug users may be at higher risk of such infections, but “they’ve informed us that injection frequency among users in not thought to be higher than in prior years.”
The symptoms of iGAS include fever, chills, fatigue, vomiting and pain. Naus said the most important piece of advice she can give patients is to seek medical attention promptly when they develop symptoms so they can be prescribed penicillin or other antibiotics.
“The cardinal sign of necrotizing fasciitis is pain out of proportion to the injury.”