Doctors watching for severe strep A infections in Alberta children, say cases could be rising

Alberta doctors are keeping a lookout for invasive group A strep infections and some say they're seeing an increase in cases among children.

Health officials in Montreal announced Friday that two children had died due to complications from the illness, and there are concerns about an uptick in a number of countries, according to the World Health Organization.

CBC News asked Alberta Health officials for recent case numbers and information on any confirmed deaths. However, CBC did not receive a response by the time of publication.

Last week, a spokesperson told CBC News the department was not aware of an unusual increase in cases.

"There's no question that at the Stollery we are seeing more invasive group A strep in a short period of time than we have seen in my whole career, which is long," said Dr. Joan Robinson, a pediatric infectious disease physician at the Stollery Children's Hospital in Edmonton.

Normally, they'd see a single case in a month at the hospital, according to Robinson. During the past month, they've seen roughly eight cases.

"People of all ages can get [it]. I think the cases that I've been seeing are primarily in children 10 and under, but there's no rule that teenagers cannot have this."

Group A streptococcus can transmit from person to person without causing illness. It can also cause common infections such as strep throat.

But in rare cases, the bacteria gets into the blood stream and can spread through the body causing severe disease. Kids with this invasive form of the illness can deteriorate very quickly, according to Robinson.

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Invasive group A streptococcus (iGAS) can lead to complications, including complex pneumonia, tissue infections (including cellulitis and necrotizing fasciitis), toxic shock syndrome (leading to a drop in blood pressure and organ failure) and problems with organs, including the heart.

At Alberta Children's Hospital in Calgary, Dr. Jim Kellner is seeing it, too.

"To tell you for sure that we're seeing a lot more than usual, I can't say that. But we're definitely seeing cases of it, and there's a sense that there's more of it," said Kellner, a pediatric infectious disease specialist and professor of pediatrics at the University of Calgary.

"It's a disease that occurs all the time in the background anyway, occasionally. But not in gigantic numbers, and it comes and goes from year to year. But there's definitely a sense that there's a lot of it out there right now."

According to Kellner, group A strep often manifests as a secondary infection after someone has a viral infection and their system is weakened.

And he believes the current surge in viral illnesses — such as influenza, RSV and COVID-19 — is likely playing a role.

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"It's not just group A strep that we're seeing a lot of right now. We're seeing other bacterial infections, other streptococcal infections, and other bacteria," he said.

"My sense is — and nobody knows this for sure — is that because there's just so much viral disease around, it's no surprise we're seeing a rise in the secondary bacterial infections."

Robinson also believes the viral wave is contributing to the unusual case numbers she's seeing.

"Because when you have inflammation at the back of the throat, it gives the bacteria an easy way to get into the bloodstream."

According to Robinson, children can become very sick, very quickly.

"It's hard not to be concerned, but … there's no really simple thing we can do to prevent this from happening," she added.

Parents should not be alarmed, Kellner said.

They can watch for warning signs, including a fever that persists for more than a few days, extreme lethargy and irritability, laboured breathing and not eating or drinking well.

"Any of those symptoms that are out of keeping to how the child usually is and out of keeping to how their usual illness response is, or if the illness is persisting … please don't hesitate to be seen and don't wait at home until your child is very, very sick," he said.

"Group A strep can cause fatal disease, there's no doubt about it.…That still happens in 2022. Despite antibiotics, despite our best medical care, it can still happen."