Over 20 cases of dangerous and potentially deadly bacterial infection diagnosed in Mississauga and Brampton over 3-month period

After returning to somewhat normal numbers following a spring surge of invasive Group A streptococcus (iGAS) infections, cases of the dangerous and potentially deadly bacterial infection are again on the rise in Mississauga and other parts of Ontario. 

But while residents are encouraged not to ignore a sore throat, skin infection or other illness that suddenly worsens, health experts say fatal cases remain relatively rare and normal precautions can be taken. 

“There has been a slight uptick in deaths. Every death is tragic and we are seeing more iGAS compared to years before,” Dr. Sumon Chakrabarti, an infectious disease physician at Trillium Health Partners in Mississauga, told insauga.com.

While iGAS can be deadly, strep A infections such as strep throat, scarlet fever, impetigo and cellulitis are common and treatable with oral antibiotics. A spokesperson from Peel Public Health (PPH) told insauga.com that group A strep bacteria are common and can be found in the nose, throat and on the skin of healthy people. However, a mild infection can quickly turn serious if strep enters the bloodstream. 

“GAS can cause infection, with symptoms that include flu-like illness including fever, sore (strep) throat, rash, and skin infection presenting as redness, pain or swelling of the skin,” PPH says. 

“Rarely, GAS can enter the bloodstream, muscles or tissues where bacteria are not usually found and cause severe illness requiring hospitalization or death.” 

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According to Halton Region Public Health, symptoms of iGAS may include fever, chills, headache, rapid breathing and increased heart rate, severe pain and swelling, redness around a wound, confusion or a flat red rash over a large area of the body.

Theorizing that the uptick, which started making headlines in Europe in early 2023 before being noted in parts of Canada and the U.S., is part of a post-pandemic phenomenon of increased illness in the community, Chakrabarti says no one is entirely sure why the increase is happening and that a number of factors could be at play. 

But while the overall number of invasive strep infections remains small–and fatal infections remain uncommon–the increase is undeniable.

According to a recent report by Public Health Ontario, 540 cases of iGAS were reported in the province between Oct. 1 and Dec. 31, 2023. The report says the number of cases reported in December surpassed the 204 cases reported in May 2023–the peak of the 2022/23 season. 

December marked the highest number of recorded cases of the infection since the 2014/15 season. 

That month, health units in Timiskaming, Thunder Bay and the Kingston area reported the highest rates of confirmed iGAS cases, with upticks also reported by the Northwestern Health Unit, Algoma Public Health and the Porcupine Health Unit. The report indicates people over 65 saw the highest incidence (6.2 cases per 100,000 people), followed by children between the ages of five and nine (4.9 cases per 100,000)

The report says 48 people in Ontario died of the infection during that three-month period, with six children under the age of 10 succumbing to the disease. One death was recorded in an infant under one year of age. 

Of the 540 cases reported in late 2023, 412 people (76 per cent) were hospitalized. 

No iGAS deaths were reported in children during the same period in 2022. 

In Peel (Brampton, Mississauga and Caledon), 21 cases of iGAS were reported between Oct. 1 and Dec. 31, with a total of 86 cases reported over the entire year. 

Of those 86 cases, 11 patients had what PPH calls “a fatal outcome.” 

“While group A strep is common, and invasive infections are still rare overall, across Canada, invasive Group A streptococcal disease activity has been higher than pre-pandemic years,” a PPH spokesperson said in an email. 

“In Peel, the 2023 rate is a 91 per cent (almost double) increase compared to the five-year average in Peel.” 

Trillium Health Partners, which operates two hospitals in Mississauga and one in Toronto, confirmed its seen a rise in cases.

“In our current fiscal year, as of November 2023, we recorded 13 cases of Paediatric Streptococcus, Group A, including both typical and invasive cases,” a spokesperson said in an email to insauga.com.

“In contrast, during the same period last fiscal year, there was only one case, and in the same period in the 2021/22 fiscal year, there were two cases.”

Other nearby health units have not noticed a difference in cases.

“Although we are aware of a rise in these infections across Canada, we have not seen a notable increase to date at Halton Healthcare,” a Halton Healthcare spokesperson said in an email to insauga.com regarding iGAS infections in Oakville, Burlington and Milton. 

As for what’s driving the increase, Chakrabarti believes there are a few possible explanations. 

“Streptococcal infection can succeed a viral infection. After the virus, the tissues are inflamed and the strep in your throat can invade but most people will get just strep throat and other people could get abscesses,” he says, adding that there has been more respiratory virus activity this winter and last following the relaxation of the COVID-19 restrictions that kept many people home in 2020, 2021 and the first part of 2022.  

“That’s probably what’s underlying this. There’s an increased amount of viral inflammation. There could be a new type of strep, and they thought that was the case in Europe, but they haven’t found that consistently.” 

Chakrabarti says that while the increase in cases is noticeable, he would not call it an epidemic. He also says that while iGAS is serious, those who develop it can recover if treated promptly. 

“Last year, I would see someone with a scratch who had an infection and was feverish and had group A strep in his blood, but he wasn’t that sick. I did see some severe infections, too. From January to April, we saw a lot and in the summer, it went closer to baseline. Now, it’s certainly gone up again and it’s interesting to me that it’s coinciding with respiratory season.” 

Dr. Prasanna Selliah, the chief of pediatrics with the William Osler Health System that serves Brampton and Toronto, says that while strep activity is high, invasive cases remain rare.

“We are seeing [strep] infections similar to the rest of the province and country and predominately they are not iGAS, but our numbers are similar to many of the GTA locations,” she told insauga.com, adding that her hospitals have not seen a fatal case of iGAS in a child. 

That said, cases have been reported.  

“I don’t know how many numbers of kids we have had with invasive strep, but it’s higher than what we’ve seen previously.” 

Like Charkabarti, Selliah says the cause is likely multi-factorial. 

“I don’t think a particular cause has been identified,” she says, adding that there are some risk factors that could predispose a patient to an invasive infection. 

“If you were to have open wounds or breaks in the skin, burns, chickenpox, they can lead to higher rates of iGAS, as well as anyone who is immunocompromised will be at higher risk for IGAS.” 

As for how to prevent a serious infection, Selliah says good hand hygiene and wound management are important. 

She also says that staying current on COVID and flu vaccines can help, as strep can occur during or after a viral illness. 

“General principles apply, such as cleaning hands regularly, staying away from people if you are sick, keeping cuts and wounds clean, staying up to date on immunizations because underlying infections such as flu and COVID can predispose to strep. If you have early signs of infection, get assessed for that,” she says. 

Selliah also recommends getting children vaccinated against chickenpox (varicella), as children with chickenpox sores could be more at risk. Varicella vaccines are currently part of Ontario’s childhood vaccination program and are recommended for all children at 15 months of age. 

Both Selliah and Chakrabarti say it’s important to treat strep infections quickly and that symptoms such as persistent fever, spreading redness around a wound or difficulty breathing require immediate attention. 

“It’s hard because strep can have symptoms similar to other infections but if you have a virus and get better but suddenly get worse, seek medical attention,” Chakrabarti says. 

“Same with if you or your kid has a fever for several days or if you or your child is vomiting and can’t keep down liquids. Do as you would do for any illness. If a child isn’t rousable, seek immediate medical attention.” 

Selliah also says to seek help if a patient or their child still feels unwell after starting antibiotic treatment. 

In the event that someone is diagnosed with iGAS, PPH says close contacts of the patient could be contacted and potentially advised to take antibiotics as a preventative measure. 

While certain people (older, immunocompromised) are more at risk and certain external factors (such as being exposed to a person with strep, living in close quarters in a congregate setting or sharing needles) can also increase a person’s risk of developing iGAS, Chakrabarti says it’s not always possible to know why one person gets seriously ill and another does not. 

“It’s hard to say why one person will get very sick and another will not. When you look at cases, there’s often a risk factor such as obesity, burns, a chronic skin condition, uncontrolled diabetes, or someone with a crush injury, but it’s already a very rare thing and we do sometimes see an uptick. Others have been healthy and gotten really sick with it,” he says. 

As for how worried people should be, both Chakrabarti and Selliah say there’s no need to take extra precautions at this time. 

“Normal vigilance,” says Selliah. 

“Monitor your child and if they show signs of an unusual infection, take them to see a doctor or go to an urgent care setting. The majority of strep A infections are still non-invasive strep A infections.”

Chakrabarti also says panic is unwarranted. 

“I understand that people are worried because it sounds very scary, but putting it into perspective, it’s still extremely rare,” he says. 

“Strep is not a foreign bacteria from a pandemic. It’s a natural bacteria that lives in all our bodies. Most people who get infections will fight it off on their own or with antibiotics. It’s reasonable to have a baseline worry, but you don’t need to completely change your behaviour or shake in your boots.”