At least 3 kids die from Strep A as infections on rise among children in Canada

At least three children in Canada have died after being infected with group A streptococcal bacteria in recent weeks, with the mother mourning the death of her nine-year-old in B.C. warning parents to watch for signs and push for vigilance from health professionals.

On Friday, the World Health Organization published an update on the increased incidence of scarlet fever and invasive group A streptococcal infections in at least five countries — just hours before Montreal’s public health authority issued a release reporting the city has seen four cases since mid-November and two children have died after infection.

Compared to the same period in 2017 to 2021, there were zero to one cases of invasive infections among children in Montreal, the public health authority in that city said. The recent cases involve children under two.

“Given the international epidemiological situation and the uncertainty regarding the respiratory virus season, we call on healthcare professionals to increase their vigilance in the face of anyone who presents symptoms compatible with a GAS invasion, in particular children,” the Montreal release reads.

Strep A, or group A Streptococcus, are bacteria that cause many group A streptococcal (GAS) diseases that range in severity, including strep throat, sinus infections, skin wounds or infections, and fever and rash, or scarlet fever, according to the government of Canada.

Only invasive group A Streptococcal (iGAS) disease — when bacteria enter the blood or deep tissue — is nationally notifiable in Canada, which makes it difficult to determine how many cases of Strep A are circulating. In Ontario, 756 cases of iGAS were reported in 2022 (up to Nov. 30) compared to 804 cases in 2021, and they include all age groups.

As there appear to be no reports of increased antibiotic resistance, the WHO said the risk for the general population for iGAS infections remains low, but, with an increase in respiratory viral infections plaguing Canada’s hospitals and children’s health care, secondary bacterial infections may be on the rise.

In the U.K., one of the countries the WHO included in its report, health authorities issued a warning to parents about Strep A and scarlet fever as deaths caused by the infection continue to rise in children, with at least 13 children under age 18 dying this season.

Chrissy Loseth told the Star that her daughter, Ayla, died from a severe reaction to Strep A bacterial infection on Nov. 29, and she is warning parents to look out for the signs and push for vigilance from health professionals.

“I do believe if she was given antibiotics earlier she might have had a fighting chance,” Loseth told the Star over text. “I am very upset with the way that the doctors had no sense of urgency with her care.”

The family thought that symptoms Ayla exhibited on Nov. 26, including a severe rash all over her body, dehydration, nausea and fever, were something more than the flu, and Loseth insisted on testing for strep infection.

She said a doctor at Kelowna General Hospital conducted the tests but said Ayla had flu symptoms, and sent the family home to wait for results.

By Monday, Ayla took a turn for the worse and the family rushed back to the hospital. But once positive tests for both the flu and strep came in, and a second doctor recognized that Ayla had gone septic, it was too late, according to the Loseths.

Doctors administered antibiotics and prepared to airlift Ayla to Vancouver Children’s Hospital for treatment, but Ayla died away in the early hours of Nov. 29.

“Ayla in fact did not die from flu complications,” Loseth said. “She died from Strep A bacteria that I insisted they test for and (doctors) did not treat properly.”

Her death shocked parents in the region, and made some desperate for answers on whether there was an outbreak of scarlet fever in the area, according to families interviewed by the Star. Loseth did not answer a question from the Star on whether she thought her daughter’s illness was scarlet fever.

The Interior Health regional authority, which delivers publicly funded health services to the interior region of B.C., said in a statement that it was conducting an internal investigation. The authority declined to comment on Ayla’s case, citing privacy concerns.

“Interior Health will fully review the case to identify any possible opportunities for learning or system level improvements as part of our ongoing commitment to quality and patient safety in our hospitals.

“Our thoughts continue to be with the family, friends and all those impacted by this loss.”

B.C.’s Centre for Disease Control said there have been 16 cases of pediatric iGAS in 2022.

Toronto’s Hospital for Sick Children said it has treated kids for Strep A recently, cases of which “appear to be related to the recent rise in respiratory viral infections,” said Jessamine Luck, the senior communications adviser for the hospital. And the number of cases is “consistent with the possibility that they could be secondary bacterial infections.”

The hospital was unable to share exactly how many cases of Strep A infections it has treated.

Strep throat can lead to scarlet fever, said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Toronto’s Mount Sinai Hospital. She said respiratory infections, say, influenza, COVID or RSV, can also lead to Strep A infection.

“If you get a viral respiratory infection, you damage the cells of your upper respiratory tract,” said McGeer. “And when you infect the surface lining and damage the cells, you allow bacteria to get through the most important organ in your body that protects you: your skin and the mucous membranes that line your respiratory and GI tracts.”

Another reason there’s an uptick in Strep A infections is because it’s passed person to person.

“There’s been less of it in the last two and a half years, so in the same way we’re catching up with respiratory viral infections, we’re catching up with group A strep infections,” said McGeer, adding that one way to protect against infection is to be vaccinated for COVID-19 and influenza.

Most children infected with Strep A will present mild cases but should be treated to prevent spread and complications, said Dr. Anna Banerji, a pediatric infectious diseases specialist at the University of Toronto’s Temerty Faculty of Medicine. Banerji added it can easily be diagnosed and treated.

To prevent the spread of Strep A, Health Canada suggests proper hand hygiene and sneezing or coughing into a tissue, and disinfecting frequently touched surfaces and objects.

Banerji said wearing a mask would also help prevent the spread of these contagious infections.

People experiencing symptoms of GAS infection like bumps, blisters, pneumonia, an unsafe drop in blood pressure, vomiting and diarrhea, among others, should seek medical care, Health Canada said.

Correction — Dec. 17, 2022: This story has been updated from a previously published version to fix that Strep A is bacteria, not a virus and to clarify that Dr. Anna Banerji advises that children who are really sick should seek treatment.

Joanna Chiu is a B.C.-based staff reporter for the Star. She covers global and national affairs. Follow her on Twitter: @joannachiu

Alessia Passafiume is a GTA-based staff reporter for the Star. Reach Alessia via email: apassafiume@torstar.ca