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Group A Streptococcus Increase in cases of invasive infections in Quebec
The “significant increase” in cases of invasive group A streptococcal infections is particularly marked among children aged 6 months to 9 years and is observed across the province.
More than 300 cases of invasive group A streptococcal infections, likely to cause flesh-eating disease, have been reported in Quebec in recent months. This is a 55% increase in infections compared to previous years, warns the Ministry of Health and Social Services (MSSS).
Posted at 5:00 a.m.
Alice Girard-Bosse
LA PRESSE
From August 28 to February 11, 347 cases of invasive infections were reported in Quebec compared to an average of 223 cases for the same period between 2015 and 2019, warned the MSSS in its April newsletter for professionals. of health. This “significant increase” is particularly marked among children aged 6 months to 9 years and is observed across the province.
A non-invasive group A streptococcal infection can manifest itself in different ways, including pharyngitis, tonsillitis, or a skin infection such as impetigo or scarlet fever.
However, some people will develop a so-called invasive infection, which can lead to serious and even fatal complications, such as flesh-eating disease, toxic shock syndrome or meningitis.
Over the past ten days, at the Pierre-Le Gardeur hospital in Terrebonne, four people presented with serious infections and were carriers of group A streptococcus. "This represents a temporary increase, the situation deserves to be followed to validate if it will persist over time, ”said the director of public relations of the CISSS de Lanaudière, Pascale Lamy.
The current investigation does not indicate any epidemiological link between these people. An antibiotic has been prescribed to close contacts, to prevent new cases from occurring, said Ms. Lamy .
For Dr. Donald Vinh, infectious disease specialist and microbiologist at the McGill University Health Center, these four cases, presumably of flesh-eating disease, in one week represent “a signal that we must be careful”.
This is an infection that can progress extremely quickly, “within hours,” says Dr. Vinh . “It can be catastrophic and lead to amputations or death. »
Infected patients usually present to hospital with fever, nausea, vomiting and a purple or red leg, Dr. Vinh observes . “In a few hours, their condition can deteriorate. Healthcare workers are trained to be alert for these types of symptoms, because sometimes you have to get the patient straight to the operating room,” he says.
Widespread rise in cases
The resurgence of respiratory viruses after the relaxation of sanitary measures could explain this increase in invasive infections, estimates the Ministry.
Invasive strep A infections usually follow viral respiratory tract infections. This was the case this fall in Quebec, where the increase in cases of invasive infections followed the increase in the number of influenza cases.
Moreover, this increase in cases in Quebec is not an isolated phenomenon. Their number is also increasing significantly in many European countries, including the United Kingdom, France, Ireland and Sweden. The Netherlands and the United States are also reporting an increase in cases among children, the ministry notes.
“The proportion of cases in children seems higher than during the pre-pandemic years, and several deaths have also been reported,” indicates the MSSS in its information bulletin.
Strep A is transmitted through respiratory droplets or through direct contact with the bacteria, such as pus, notes Dr. Vinh . Since there is no vaccine against these infections, good hygiene practices, such as washing hands and surfaces, can limit the transmission of these infections. For its part, the CISSS de Lanaudière reminds us that we must be vigilant and consult quickly if a wound infection occurs.
https://www.lapresse.ca/actualites/...-des-cas-d-infections-invasives-au-quebec.php
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Flash Vigie
Quebec newsletter for monitoring, surveillance and intervention in the protection of public health
April 2023 Vol. 17, No. 1
Invasive group A streptococcal infections
General
Streptococcus pyogenes, better known as
group A streptococcus (GAS), is a bacterium that
transmitted by droplets or by direct contact with a
infected wound. GAS infection can be invasive or
Non invasive.
Non-invasive infection may manifest as
pharyngitis with sore throat, lymphadenopathy
neck pain and fever. It can also appear as
the form of a skin infection such as impetigo,
cellulitis or scarlet fever.
It is important to identify these infections early and
to treat them with appropriate antibiotics in order to
decrease the spread and prevent their complications
such as acute articular rheumatism, rheumatism
heart and kidney damage.
An infection is considered invasive when the
bacteria ends up in a normally sterile site of
the organism. An invasive streptococcal infection of the
group A (IISGA) can lead to serious complications
and even fatal [1].
Epidemiological situation
Since autumn 2022, there has been an increase in
the incidence of AGII both in Quebec and in other
Canadian provinces and other countries.
Internationally. The number of cases of AGII is increasing
significant increase in several European countries, including the
UK, France, Ireland and Sweden [2, 3, 4]. THE
Netherlands additionally reports an increase in cases
in children, much like the United States [5, 6]. Fact,
the proportion of cases in children appears to be higher
than in the pre-pandemic years, and several
deaths have also been reported. In the UK, the rise
of AGII cases coincides with an increase in cases
of scarlet fever [3].
In Canada. Only cases of invasive infection are to be
compulsory declaration, and this, since January 2000 [7]. In
Ontario, for the last three months of 2022, the number
of IISGA exceeds that of the period 2015-2019 [8]. In
British Columbia, despite a lower incidence rate
in 2022 than the average rate of the previous five years
(2017 to 2021), an increase in the incidence rate and the rate
lethality is recorded in December, especially among
over 60 years [9].
In Quebec. A significant increase in cases of AGII
for the whole population was also observed. Of
August 28, 2022 to February 11, 2023, 347 cases of AGII have been
declared against an average of 223 cases for the same
period between 2015 and 2019, i.e. incidence rates
3.97 and 2.67 per 100,000 people respectively.
Several health regions reported a number
increased number of cases compared to the average number of cases
pre-pandemic years. This tends to demonstrate a
geographical dispersion of the phenomenon within the
province.
This increase affects most age groups, but is
greater in children aged 6 months to 9 years. Between
August 2022 and February 2023, there are 54 cases of AGII in
this age group, compared to an average of 23 cases
for the years 2015 to 2019 (respective incidence rates
6.11 and 2.59 per 100,000 people).
IISGAs typically track infection activity
viral infections of the upper respiratory tract such as
flu [10]. As shown in Figure 2, the increase
of AGII cases in the fall of 2022 followed the rise of the
peak in the percentage of positive influenza tests. Over there
As a result, the number of cases is also decreasing,
less marked compared to the steep and pronounced fall
of influenza activity, to tend towards the values
expected for this time of year.
Genotypes in circulation
The M protein, encoded by the emm gene, is one of the
GAS virulence markers [8]. According to the results of
characterization of IISGA strains carried out by the
National Microbiology Laboratory (NML) Winnipeg,
the most frequent genotypes in Quebec in 2022 are
the emm-1, the emm-89, the emm-12, the emm-49, the emm-76
and the emm-53. All these genotypes circulated in Quebec
from 2018 to 2020 and are still circulating.
The emm-1.3 genotype, also called M1uk, is a subtype of emm-1
discovered in 2010 in London. It has been described
as hypertoxigenic, i.e. it would be of great virulence [11].
The emm-1.3 has been present in Canada for 2015 [8].
According to the NML, 27% of emm-1.3 strains detected
between 2015 and 2021 were detected in children aged
under 15 years old. In Quebec, 54% of emm-1.3 strains
detected in 2022 come from children under the age of
15 years [12].
...
Factors that may explain the increase in cases
of IISGA
During the COVID-19 pandemic, the establishment of a
panoply of health measures has led to a decrease
infections related to common respiratory viruses,
such as respiratory syncytial virus (RSV) and
influenza, and infections associated with GAS. He would have
resulted in a decrease in the acquisition of immunity against these
pathogens [13]. Relaxation of sanitary measures
has been accompanied by a resurgence of these infections
viral respiratory. Since coinfection with respiratory viruses is likely to predispose to
IISGA, the resurgence of respiratory viruses may be a
factor explaining the increase in AGII cases [3, 4, 10]. There
situation reported in France also tends to support
this hypothesis whereas more than half of the cases
pediatric cases of hospitalized SGAI occurred following
of a viral respiratory infection [4].
Faced with this resurgence of cases of IISGA,
the World Health Organization (WHO) does not report
for its part, neither a new strain nor a resistance to
antibiotics. WHO further estimates that the risk of
present the IISGA for the general population remains
currently low [2].
Intervention in the presence of an IISGA
Chemoprophylaxis is recommended for
close contacts of IISGA who meets the severity criteria,
i.e. pneumonia, meningitis, shock syndrome
toxic, necrotizing fasciitis or death related to AGII [14].
This prophylaxis should be administered as soon as
as soon as possible, ideally within 24 hours
following identification of the severe case, and is recommended
up to 7 days after the last exposure.
To be considered a close contact, the person
must have been exposed to the severe case of AGII during his or her
period of contagiousness, this ranging from 7 days
preceding the appearance of the first symptoms until
24 hours after the start of antibiotic treatment.
Other criteria are taken into account to determine whether
is a close contact, for example the fact that the
person lives under the same roof as the case, shares the same
bed, had sex with the case, etc. [14]
Recommendations
There is currently no vaccine against
GAS infections. Good hygiene practices remain
the only way to limit the transmission of these infections.
Faced with the increase in the incidence rate of AGII in
Quebec, especially among children, calls for
vigilance have been distributed to clinicians in order to
inform them of the situation and the interventions required.
In the presence of clinical manifestations compatible with
an infection, invasive or not, with SGA, the interventions
following are recommended [14]:
1. Take the required samples and quickly offer the
adequate antibiotic treatment;
2. Apply Routine Practices and Precautions
additional recommended depending on the condition of the user
and the causative pathogen;
3. Give instructions to reduce the risk of
transmission and complications;
4. Promote vaccination against influenza and
varicella according to the Quebec Immunization Protocol;
5. Declare any case of notifiable disease
to the DSPublique of the region of residence of the case in
as soon as possible for treatment
rapid contact and monitoring of epidemiology.
At the national level, surveillance of strains
responsible for IISGA by the NML continues.
For optimal use of diagnostic tests and
antibiotics, clinicians are encouraged to consult the guide
of optimal use on pharyngitis-tonsillitis produced by
the National Institute of Excellence in Health and Services
(INESSS) [15].
Conclusion
In Quebec as in several Canadian provinces
and several other countries, the number of IISGA is increasing
significant increase compared to the five seasons
pre-pandemic. Young children aged 6-11 months and
1-4 years are the most affected with the lowest incidence rates
higher (Figure 1).
This increase in cases follows the activity of respiratory viruses and
explained neither by a new strain nor by a
possible antibiotic resistance.
Considering the complications of AGII and the number of
deaths already recorded, public health measures have
been implemented in order to counter this
upsurge; vigilance remains in order and the Management of
the health watch continues to closely monitor
the evolution of the situation.
Authors:
Camille Audet and Nathan Blanchard, medical students,
Université Laval, in collaboration with the Direction générale
Public Health Assistant.
Also participating in this issue: Colette Gaulin, MarieAndrée Leblanc,
Lisvia De Wekker, Thierry Gahungu, Annick Des Cormiers,
Eveline Toth, France Markowski, Josée Dubuque and
Yves Jalbert, Department of Health Monitoring (MSSS).
...
https://publications.msss.gouv.qc.ca/msss/fichiers/flashvigie/FlashVigie_vol17_no1.pdf
https://publications.msss.gouv.qc.ca/msss/document-003398/
