City fights outbreak of strep at shelter

Health officials test residents at Seaton House where 37 men have been sickened this year

Toronto public health officials are battling an outbreak of group A strep that has sickened 37 people at Seaton House shelter for homeless men.

Five of the men have been treated for the potentially deadly “invasive” strain.

Officials this weekend are testing staff and more than 170 residents living on the George St. shelter’s third and fourth floors, where there are residents known or thought to have the bacterial infection.

Public health hopes to have results from the throat swabs early next week and use antibiotic treatment to stamp out the persistent bug. The city is also consulting two outside experts, one in Toronto and another in Minnesota, for help.

“Because of the patient population we’re dealing with, this is a tough outbreak,” said public health’s Dr. Michael Finkelstein in an interview Friday with the Star.

“This is a very complex situation because of the vulnerability of the patient population, the fact that we’re dealing with a shelter population” who are clustered together long-term, more prone to skin breaks and who, because of mental illness and other causes, might resist treatment.

People can carry group A streptococcus in their throat or on their skin without showing any symptoms.

Thirty residents and two staff developed “superficial” infections, including strep throat, which usually makes swallowing difficult and painful, as well as fever and minor skin infections.

Five residents suffered invasive group A strep, which can lead to flesh-eating disease, meningitis or sepsis — a body’s traumatic response to infection that can cause organ failure, tissue damage and even death.

“Almost all of them were of the bloodstream infection type, so people had the bacteria in their blood, and that can cause serious illness,” Finkelstein said.

“All of them have had to go to hospital,” including one with bacteria and resulting fluid found near a lung, he said. “That person had cough, severe cough, and again, they had septic shock, and they (got) really, really quickly sick.”

One Seaton House resident with invasive group A strep plus multiple other health problems died, Finkelstein added. He was treated for the strep infection “and then . . . died from something else.”

The city has beaten group A strep outbreaks before within a couple of months, Finkelstein said. More than four months after March tests revealed some residents had the same type of group A strep, triggering the declaration of an outbreak, they haven’t stamped it out.

According to the Atlanta-based Centers for Disease Control and Prevention, group A strep is spread through direct contact with mucus from the nose or throat of people already infected, or through contact with infected wounds or sores on the skin.

Sick people with symptoms are more likely to spread the infection than those with no symptoms. It is possible to spread the bacteria by drinking from the same glass or eat- ing from the same plate as somebody sick with a group A strep infection such as strep throat.

The outbreak moved from Seaton House’s third floor to the fourth.

In a practice called “cohorting,” rooms on those floors have been set up for infected residents undergoing treatment to decrease the risk of spread.

Once test results are back, anyone with group A strep, including those without symptoms, will take antibiotic pills over 10 days.

Seaton House staff are also being reminded of transmission prevention controls, including frequent handwashing.