​British Columbia continues to experience higher levels of invasive group A streptococcal (iGAS) infections than usual, especially among children. Following a December 2023 bulletin about elevated levels of iGAS infections, updated data from 2023 now show 60 cases reported in people under the age of 20, three times as many infections reported in this age group for 2022.

Invasive bacterial infections tend to be more common during winter months, in association with viral respiratory infections. Though deaths associated iGAS infection in children are rare, severe outcomes have been reported this respiratory season.

In total since mid-December, BC Centre for Disease Control (BCCDC) has received reports of four deaths in children under the age of 10 where group A streptococcus was identified alongside viral respiratory illness. This includes two deaths previously reported by BCCDC where group A streptococcus was identified alongside influenza. BCCDC has also received reports of two deaths where group A streptococcus was identified alongside human metapneumovirus, another respiratory illness.

Bacteria known as Streptococcus pyogenes, group A, typically cause mild illnesses. Infections can become more dangerous when the bacteria invade the lungs, blood, or spread along the tissue surrounding a muscle. Sometimes this can happen after a viral respiratory infection.

These more severe iGAS infections can cause pneumonia or sepsis, including life-threatening conditions such as toxic shock syndrome and necrotizing fasciitis. These present a higher risk to people at either end of the age spectrum, people with chronic illnesses such as cancer, diabetes, chronic heart or lung disease, and people who take medications such as steroids.

Serious infections are extremely rare, but the BC Centre for Disease Control and BC Children’s Hospital want to make families aware of the following notable symptoms:

• A fever for more than five days in a child of any age,
• Fever with either a fine red rash (sandpaper-like texture), full body rash similar to sun burn, and/or red, swollen tongue.
• A fever in a child under three months of age, a child with immune system issues or complex chronic health conditions.
• A child struggling to breathe (e.g. chest appears to sink in just above or below the breastbone with each breath, you may hear grunting or notice the head bobbing with each breath in a young infant).
• Pale skin, whitish or blue lips.
• A child who is very sleepy or having difficulty waking up, or
• A child becoming very sick, very quickly.

If a child is experiencing any of these symptoms, seek medical care immediately at your nearest emergency department or urgent and primary care centre, if available in your community.

Steps to prevent serious illness

There is no vaccine to prevent group A streptococcal infections, however, there are steps you can take to prevent illness in general:

• Regularly clean your hands
  
• Clean wounds and monitor for signs of infections
• Stay up to date on immunizations, including updated COVID-19 and influenza vaccines, that offer protections against two circulating respiratory viruses
  
• Stay at home when sick to prevent the further spread of illness
  

If you have questions about invasive group A streptococcal infections, contact a healthcare provider or call HealthLinkBC at 8-1-1 for free healthcare guidance at any time.

Rates of iGAS infections increasing in B.C. since 2016 

• In 2016, there were 303 cases reported in B.C. across all age groups, a rate of 6.2 cases per 100,000 people.
• In 2022, there were 466 cases reported in B.C. across all ages, a rate of 7.4 cases per 100,000 people.
• In 2023, there were 586 cases reported in B.C. across all ages, a rate of 10.8 cases per 100,000 people.
  
• In 2023, five deaths were reported in children under the age of 10 where group A streptococcus was identified. One death was reported in a child under 10 years in 2022.
  

Several other countries and regions in Canada have also seen a higher frequency of these infections in children.

Learn More:

• BC Children’s Hospital: When to seek emergency care and when to find alternative options
• Streptococcal Disease, Invasive, Group A
  

The BC Centre for Disease Control, a part of the Provincial Health Services Authority, provides public health leadership through surveillance, detection, treatment, prevention and consultation services. The Centre provides diagnostic and treatment services for people with diseases of public health importance, and analytical and policy support to all levels of government and health authorities. The BCCDC also provides health promotion and prevention services to reduce the burden of chronic disease,  preventable injury and environmental health risks. For more, visit www.bccdc.ca  or follow us @CDCofBC.

BC Children’s Hospital, a program of the Provincial Health Services Authority provides expert care for the province’s most seriously ill or injured children, youth and young adults, including newborns. Child and Youth Mental Health provides a diverse range of specialized and one-of-a-kind tertiary mental health and substance use services for children, adolescents and young adults across the province. For more information, visit www.bcchildrens.ca or follow us @BCChildrensHosp.

The Provincial Health Services Authority (PHSA) provides specialized health care services and programs to communities across British Columbia, the territories of many distinct First Nations. We are grateful to all the First Nations who have cared for and nurtured this land for all time, including the xʷməθkwəy̓əm (Musqueam), Sḵwx̱wú7mesh Úxwumixw (Squamish), and səlil̓w̓ətaɬ (Tsleil-Waututh) First Nations on whose unceded and ancestral territory our head office is located. We work in partnership with other B.C. health authorities and the provincial government to deliver province-wide solutions that improve the health of British Columbians. For more information, visit www.phsa.ca or follow us @PHSAofBC.