What is Invasive Group A Streptococcal Disease. How does it differ from common strep infections. Why are health officials in Ontario issuing alerts about iGAS. What are the symptoms and risk factors associated with invasive group A strep.

Understanding Group A Streptococcal Infections: From Common to Invasive

Group A Streptococcus (GAS) is a bacterium that can cause a wide range of infections, from mild to severe. While many people are familiar with common strep throat, the invasive form of this infection has been raising concerns among health officials in Ontario and beyond.

Group A strep typically resides harmlessly in the throat or on the skin, spreading through respiratory droplets or direct contact with secretions. In most cases, GAS infections are mild and easily treated with antibiotics. However, in rare instances, the bacteria can invade deeper tissues, leading to more serious conditions.

Common Group A Strep Infections:

• Strep throat
• Skin infections (e.g., impetigo)
• Scarlet fever

The Rise of Invasive Group A Streptococcal Disease (iGAS) in Ontario

Recent data from Public Health Ontario has revealed a concerning trend in Invasive Group A Streptococcal Disease (iGAS) cases. Since January 2023, there has been a notable increase in reported cases, with April showing the highest monthly count since the 2014-15 strep season.

Toronto Public Health has also reported a “higher than expected” increase in iGAS cases since November 2022, with May 2023 cases rising to more than twice the pre-pandemic average for that month.

iGAS Case Statistics in Ontario:

• 894 cases reported between October 1, 2022, and April 30, 2023
• 6 children under 18 and 113 adults died during this period
• April 2023 saw close to 180 cases province-wide

Identifying Invasive Group A Streptococcal Disease: Symptoms and Complications

Invasive Group A Streptococcal Disease occurs when the bacteria enter the bloodstream, joints, or deep muscle tissue. This invasion can lead to severe and potentially life-threatening conditions.

Serious Complications of iGAS:

1. Pneumonia
2. Meningitis
3. Septicemia (blood poisoning)
4. Necrotizing fasciitis (flesh-eating disease)
5. Streptococcal toxic shock syndrome

How quickly can iGAS progress? Invasive Group A Streptococcal Disease can progress rapidly, potentially leading to severe illness within a short timeframe. This rapid progression underscores the importance of early recognition and prompt medical intervention.

High-Risk Groups for Invasive Group A Streptococcal Disease

While iGAS remains relatively rare, certain groups are at higher risk of developing this severe form of infection.

Individuals at Increased Risk of iGAS:

• Young children (especially those 4 years and under)
• Adults aged 65 and older
• Pregnant individuals and those who recently gave birth
• People with weakened immune systems (e.g., undergoing chemotherapy or living with HIV)
• Individuals with chronic diseases

Why are these groups more susceptible to iGAS? These populations may have compromised immune systems or physiological factors that make them more vulnerable to invasive infections. For instance, young children’s immune systems are still developing, while older adults may have weakened immune responses due to age-related factors.

Ontario’s Health Alert: Physicians on High Alert for iGAS

In response to the rising cases of iGAS, Ontario’s Ministry of Health has issued a memo to healthcare providers across the province. This alert aims to increase awareness and vigilance among medical professionals to ensure early detection and treatment of invasive group A strep infections.

Key Points from the Health Alert:

• Pediatricians, primary care providers, and hospital physicians are asked to be on lookout for signs and symptoms of iGAS
• Special attention is requested from emergency departments and labor and delivery units
• Physicians are urged to “be on the alert” for the disease, which can quickly lead to severe illness

Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, emphasized in the May 23 memo the importance of heightened awareness among healthcare providers. This proactive approach aims to facilitate early diagnosis and intervention in potential iGAS cases.

The Global Context: iGAS Increases Beyond Ontario

The rise in Invasive Group A Streptococcal Disease cases is not limited to Ontario. Health authorities worldwide have observed similar trends, prompting alerts from organizations such as the U.S. Centers for Disease Control and Prevention.

Why did iGAS cases drop during the pandemic? The decrease in iGAS cases during the COVID-19 pandemic is attributed to widespread public health measures such as masking and social distancing. These precautions not only helped control the spread of COVID-19 but also reduced the transmission of other respiratory pathogens, including group A strep.

Factors Contributing to the Recent iGAS Increase:

1. Lifting of pandemic-related public health measures
2. Recent spike in circulating respiratory viruses (COVID-19, influenza, RSV)
3. Potential link between iGAS infections and respiratory virus infections

How do respiratory viruses contribute to iGAS risk? Epidemiological studies suggest a correlation between iGAS infections and respiratory virus illnesses. When the body is fighting off a viral infection, it may become more susceptible to bacterial invasions, potentially increasing the risk of severe strep infections.

Medical Community’s Response to the iGAS Alert

The medical community in Ontario has responded positively to the provincial alert on Invasive Group A Streptococcal Disease. Healthcare providers are incorporating this new information into their clinical practice to enhance patient care and disease prevention.

Dr. Allan Grill, chief of family medicine at Markham Stouffville Hospital, noted an increase in non-invasive strep A infections during the winter and spring of 2022-2023. He welcomed the provincial alert, stating, “This (memo) puts our radar up a bit, it makes us look for things a little bit more.”

Impact of the Alert on Clinical Practice:

• Increased vigilance for signs and symptoms of iGAS
• Enhanced awareness of the potential for rapid disease progression
• Greater emphasis on early diagnosis and prompt treatment

How should the public respond to this information? While the increase in iGAS cases is concerning, Dr. Grill emphasizes that the public should not panic. Invasive Group A Streptococcal Disease remains a rare occurrence. However, he stresses the importance of taking the infection seriously and seeking medical attention if concerning symptoms arise.

Preventing and Managing Group A Streptococcal Infections

While the focus has been on the rise of invasive cases, it’s crucial to understand that most group A strep infections are mild and easily treatable. However, proper prevention and management strategies can help reduce the risk of both common and invasive infections.

Prevention Strategies for Group A Strep Infections:

• Practice good hand hygiene
• Cover your mouth and nose when coughing or sneezing
• Avoid close contact with individuals who have strep throat or skin infections
• Maintain a healthy lifestyle to support immune function

How effective are antibiotics in treating group A strep infections? Antibiotics are highly effective in treating group A strep infections, including invasive cases. Early antibiotic treatment can prevent the progression of mild infections to more severe forms and reduce the risk of complications.

Managing Group A Strep Infections:

1. Seek medical attention if you suspect a strep infection
2. Complete the full course of prescribed antibiotics, even if symptoms improve
3. Rest and stay hydrated to support recovery
4. Monitor for any worsening symptoms or signs of invasive infection

What are the signs that a strep infection may be becoming invasive? While rare, it’s important to be aware of symptoms that may indicate a progression to invasive disease. These can include high fever, severe pain, rapid heartbeat, difficulty breathing, or a rash that spreads quickly. If you experience these symptoms, seek immediate medical attention.

The Role of Public Health Measures in Controlling Infectious Diseases

The COVID-19 pandemic highlighted the effectiveness of public health measures in controlling the spread of infectious diseases. As we’ve seen with the fluctuation in iGAS cases, these measures can impact a wide range of pathogens beyond their primary target.

Lessons Learned from the Pandemic:

• Importance of hand hygiene and respiratory etiquette
• Effectiveness of physical distancing in reducing disease transmission
• Value of staying home when ill to prevent spread of infections
• Role of personal protective equipment in healthcare settings

How can we apply these lessons to prevent future outbreaks? While stringent pandemic measures may not be necessary for controlling group A strep, maintaining good hygiene practices and being mindful of disease transmission can help reduce the spread of various infectious diseases, including iGAS.

Ongoing Research and Surveillance of Group A Streptococcal Infections

The recent increase in Invasive Group A Streptococcal Disease cases has prompted renewed interest in research and surveillance efforts. Understanding the factors contributing to this rise and developing better prevention and treatment strategies are key priorities for public health officials and researchers.

Areas of Focus for iGAS Research:

1. Genetic factors influencing bacterial virulence
2. Host-pathogen interactions in invasive infections
3. Development of new diagnostic tools for rapid detection
4. Exploration of potential vaccine candidates
5. Investigation of the relationship between viral infections and iGAS risk

What role does surveillance play in managing iGAS? Ongoing surveillance is crucial for tracking trends in iGAS cases, identifying outbreaks, and evaluating the effectiveness of prevention and control measures. It also helps in recognizing emerging strains or changes in disease patterns that may require new approaches to management.

Importance of Collaborative Efforts:

• Sharing of data and research findings across jurisdictions
• Coordination between public health agencies, healthcare providers, and researchers
• International collaboration to address global trends in iGAS
• Engagement with communities to promote awareness and prevention strategies

How can individuals contribute to these efforts? While research and surveillance are primarily conducted by health professionals and scientists, individuals can contribute by participating in studies when invited, reporting suspected cases to healthcare providers promptly, and following public health recommendations to prevent the spread of infections.

Future Outlook: Addressing the Challenge of Invasive Group A Streptococcal Disease

As we continue to navigate the challenges posed by Invasive Group A Streptococcal Disease, a multifaceted approach involving healthcare providers, public health officials, researchers, and the general public will be crucial. The recent increase in cases serves as a reminder of the dynamic nature of infectious diseases and the need for continued vigilance and adaptability in our response.

Key Strategies for the Future:

• Enhancing public awareness about iGAS and its prevention
• Continuing to improve diagnostic capabilities and treatment protocols
• Strengthening surveillance systems to detect and respond to outbreaks quickly
• Investing in research to better understand the disease and develop new interventions
• Maintaining a state of readiness in healthcare systems to manage potential increases in severe cases

What can we expect in terms of iGAS management in the coming years? While it’s difficult to predict the exact trajectory of iGAS cases, the increased attention and resources devoted to understanding and managing this disease are likely to yield improved strategies for prevention, early detection, and treatment. However, it remains important for individuals and healthcare providers to stay informed and vigilant.

Balancing Concern and Perspective:

1. Recognize the seriousness of iGAS while understanding its rarity
2. Maintain good health practices to reduce overall infection risk
3. Stay informed about local health advisories and recommendations
4. Seek medical attention promptly if concerning symptoms arise
5. Support public health initiatives aimed at controlling infectious diseases

How can we foster a culture of health awareness without causing undue alarm? Striking a balance between promoting health awareness and avoiding panic is crucial. This can be achieved through clear, factual communication from health authorities, education about risk factors and prevention strategies, and empowering individuals to make informed decisions about their health.

Ontario warns doctors to look out for invasive group A strep

Canada

Invasive Group A Streptococcal Disease cases in April were the highest since the 2014-15 strep season.

By Megan OgilvieHealth Reporter

Thu., June 8, 2023timer6 min. read

Pediatricians, primary care providers and hospital physicians, including those who work in emergency departments and labour and delivery units, are being asked to be on the lookout for “signs and symptoms” of Invasive Group A Streptococcal Disease.

A recent memo from Ontario’s Ministry of Health, obtained by the Star, points to an increase in cases of the potentially deadly bacterial infection in the province and requests physicians be “on the alert” for the disease, which can quickly lead to severe illness.

Though Invasive Group A Streptococcal Disease (iGAS) remains rare, data from Public Health Ontario shows an increase in cases since January, with April having the highest reported monthly case count since the 2014-15 strep season.

And the most recent data from Toronto Public Health shows a “higher than expected” increase in iGAS cases since November, with cases in May rising to more than twice the pre-pandemic average for that month.

Public Health Ontario data show rates are highest among children and infants four years and under and among adults 65 and older.

Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health, requests in the May 23 memo that physicians, primary care providers and midwives “be on the alert for signs and symptoms of iGAS in your patients.

“While iGAS remains relatively uncommon it can progress quickly and may be associated with streptococcal toxic shock syndrome, sepsis … meningitis, pneumonia and other life-threatening conditions resulting in death,” Yaffe said.

Dr. Allan Grill, chief of family medicine at Markham Stouffville Hospital, a part of Oak Valley Health, said he and his colleagues have seen an increase in non-invasive strep A infections this winter and spring, including strep throat, and welcome the provincial alert on iGAS.

“This (memo) puts our radar up a bit, it makes us look for things a little bit more,” said Grill, a family physician. “The public doesn’t need to panic because (iGAS) is still a rare occurrence. But we have to take the infection seriously.”

What is invasive group A strep?

Group A strep disease is a common bacterial infection that often leads to mild illnesses that are commonly treated with antibiotics, including strep throat, skin infections such as impetigo, and scarlet fever.

The bacteria, which are typically harmless and are often found in the throat or on the skin, are spread from person to person through respiratory droplets or from direct contact with secretions from the nose, throat or wounds.

In rare cases, the bacteria can enter the blood, joints or deep muscle tissue, causing more severe and potentially life-threatening infections. These include pneumonia; meningitis; septicemia, or blood poisoning; and necrotizing fasciitis, also known as flesh-eating disease.

Young children, people who are pregnant or who recently gave birth, and adults over 60 are at greater risk of developing iGAS. People who have weakened immune systems, including those undergoing chemotherapy or who have HIV, as well as people with chronic diseases are also at higher risk.

An increase in iGAS cases

In Ontario, 894 iGAS cases were reported between Oct. 1, 2022, and April 30, 2023, with Public Health Ontario noting an increasing trend in cases since January. During that same period, six children under 18 and 113 adults died of the disease.

According to the agency’s most recent summary, iGAS cases reported each month between October 2022 to April 2023 “exceeded the number of cases for the same months in each of the five pre-pandemic seasons, with the exception of October 2017 and January 2018.”

April iGAS cases — close to 180 cases were reported province-wide — added up to the highest monthly total since the 2014-15 season, the data shows.

The rise in iGAS cases is being seen nationally and around the world with health authorities in other jurisdictions, including the U.S. Centers for Disease Control and Prevention, posting alerts. Cases of iGAS dropped during the pandemic due to public health measures such as masking and distancing.

Experts say the increase in iGAS cases may be due to the recent spike in circulating respiratory viruses — a triple threat of COVID-19, influenza and RSV hit hospitals hard last winter — alongside the lifting of public health measures. Epidemiological studies suggest a link between iGAS infections and getting sick with respiratory viruses.

Dr. Richard Hamat, a pediatrician at Humber River Hospital, said he is aware of “several” patients requiring hospitalization for iGAS in the Toronto area this year.

“These are very, very severe cases where it’s become extraordinarily aggressive in certain individuals,” said Hamat, also a pediatrician at the Vaughan Pediatric Clinic in Woodbridge. “I can’t recall any cases of invasive strep in previous years. This is very unusual.”

In a statement to the Star, Toronto Public Health said there is a “higher than expected increase in iGAS cases in recent months, starting in November, and reaching a peak in March where there were 34 reported cases compared to a pre-pandemic five-year mean of 14 cases for that month.”

Toronto data shows there were 124 iGAS cases between January and the end of May — up from 41 cases reported during the same time period the previous year. The five-year average between 2013 and 2018 for January to May was 72 cases.

What are signs and symptoms of invasive strep?

Non-invasive strep, including strep throat, can be easily diagnosed with a rapid swab, and most patients will improve within 24 hours following treatment with antibiotics, said Hamat, who advises patients book a followup appointment if they do not improve after 24 hours.

Parents should call a doctor if their child has a sore throat or rash with a high fever and doesn’t “perk up” or respond to over-the-counter pain and fever medications, he said. They should also quickly seek medical attention if their fevered child “has a change in consciousness,” such as “not appearing responsive or acting more confused,” he said.

Grill said it’s important to keep an eye on rashes and skin infections; a rash that spreads quickly, with the area hot to the touch and painful, could point to a potential invasive strep infection. Another warning sign is an extremely bad headache accompanied by a stiff neck, which could indicate meningitis caused by invasive strep.

“And if the infection gets in your blood, leading to sepsis or blood poisoning, people tend to be lethargic,” said Grill. “Whether it’s a child or an adult, if you can’t wake them up, if they’re so tired that it’s hard to rouse them, this is a red flag.”

While invasive strep infections are rare, Grill said seeking medical care quickly is key because “patients can go from feeling pretty good to getting very sick quickly, within 12 to 24 hours.”

Patients with iGAS typically require aggressive treatment with intravenous antibiotics, he said.

Are there ways to lower the risk of invasive strep?

Good hand hygiene, including washing hands after coughing and sneezing and before and after eating, can help minimize strep infections, said Grill.

Evidence shows that a previous viral infection puts someone at higher risk of invasive strep, which is why keeping up to date with routine immunizations, such as those for chickenpox and influenza, is important, he said, noting older adults also benefit from pneumococcal vaccines.

Hamat also advises parents about the benefits of vaccines and that having a child vaccinated against chickenpox will help lower the risk of iGAS.

“Chickenpox has always been a risk factor for invasive strep but now potentially even more so,” he said. “We can’t vaccinate against strep, but we can have timely doctors’ visits when you’re sick, know the signs and what to look out for and prevent one of the risk factors by keeping up with your usual vaccinations.”

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie or reach her via email: [email protected]

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Ontario hospitals on alert for invasive Group A strep

Ontario hospitals and pediatric physicians are being told to “be alert” for symptoms of invasive Group A Streptococcal Disease (iGAS) after an “increasing trend” has been identified.

In a memo obtained by CTV News Toronto, dated May 23, the province’s associate chief medical officer of health said an increase of cases had been reported in Ontario among all age groups, including children under the age of 18.

“Rates of illness are highest among those aged 0 to 4 and 65 years of age and older,” Barbara Yaffe wrote in the memo. “Others at increased risk include those with immunocompromising conditions, chickenpox, and people experiencing homelessness or who use injection drugs.

“In a recent report from the United States, some children with iGAS had preceding or concurrent respiratory viral infections.”

The memo was sent to emergency departments, labour and delivery units, and primary care organizations.

Group A Strep (GAS) is an infection caused by bacteria that spreads from person-to-person through direct contact with the nose, throat, respiratory droplets or wound secretions. The common non-invasive illnesses include strep throat, skin infections, such as impetigo, and scarlet fever.

It often can be treated with antibiotics.

According to Public Health Ontario, GAS becomes “invasive” when the bacteria enters the blood stream or deep tissue. The health agency says this can result in severe, life-threatening illness such as pneumonia, meningitis, septicemia, and other serious diseases.

Health-care providers are being asked to provide prompt assessment and treatments for non-invasive GAS, and to be alert for potential complications.

If invasive GAS is suspected, specimens should be collected for testing. Public health units should be notified of any cases and clusters, the memo says.

Public Health Ontario says 894 cases of iGAS were reported in the province between October 2022 and April 30, 2023.

The most recent report says an “increasing trend” of iGAS has been seen since January.

“The total number of iGAS cases reported in April 2023 is the highest monthly case count reported to date since the 2014/15 season,” the report, published in May, notes.

The majority of cases were found in individuals over the age of 18, however 45 children between the ages of one and four were also diagnosed with iGAS.

About 74 per cent of patients were hospitalized as a result.

Yaffe noted in the memo that officials are “closely monitoring the situation” and further updates will be provided if there are any new developments.

WHAT ARE THE SYMPTOMS?

Individuals with Group A Streptococcus can experience multiple flu-like symptoms depending on the disease.

This includes:

• 
  Sore throat
• 
  Rash
• 
  Scabs and sores
• 
  Pain and swelling
• 
  Fever
• 
  Severe muscle aches
• 
  Nausea and vomiting

The symptoms may be more intense for those with invasive diseases and can include dizziness, neck stiffness, breathlessness, chest pains, abdominal pain, confusion, and bleeding or pus at infection sites.

Sports shooting – types and rules

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CHAMPIONSHIP TICKETS

Anti-Doping

bullet shooting

Bench shooting

Formation and types of sports shooting

Man’s thirst for rivalry and self-development has given birth to various competitive disciplines since ancient times. We can say that the history of sports shooting begins with the invention of long-range weapons (crossbow, bow). With the invention of gunpowder, this sport became more similar to the modern one. In the middle of the XIV century, the first shooting competitions and a new set of rules for athletes appeared. At 1896 year this discipline appeared at the Summer Olympic Games in Athens and since then has been a permanent component of the program. Initially, the competition was held among men. Women were first allowed to participate in 1968 in Mexico City. Athletes competed with each other on an equal footing. Shooting has been separate since 1996. Now 15 sets of medals are played in this discipline. There are different types of sports shooting and exercises.

The rise of sports shooting

• Germany hosted one of the first ever shooting tournaments in Augsburg in 1432. Since then, their popularity has steadily grown. In the 19th century, more than 712 sportsmen’s unions were formed.
• In England the first shooting society was founded in 1859, and in 1860 an open competition was held among its members.
• In Switzerland, marksmanship competitions were recorded as early as 1452. From then to the present, annual shooting festivals and competitions have been held in the country.
• In USA the first competition was organized in 1873. Already at that time, each city had its own sports community.
• In Russia the first competitions were held on May 25, 1898 in Khabarovsk. Since then, official shooting championships have been held in the country every year and in various disciplines, including army ones.

Sports shooting

• Bullet. Produced for static and moving targets from pneumatic, small- or large-caliber weapons.
  • From a rifle. Shooting is carried out from three main positions: standing, kneeling or lying down. Mostly single-shot rifles are used. The distance to the target varies from 10 to 300 meters depending on the type of exercise.
  • From a pistol. Shooting is carried out only from a standing position. The gun is in one hand. For exercises, revolver-type weapons with a large caliber (from 7.62 to 9.65 mm) can be used.
  • Moving target. Shooting is carried out from a single-shot rifle. Targets move in different directions horizontally, passing through a special window. The athlete shoots only from a standing position and only when the target is in the window.
• Bench. Sports shooting takes place on an open range and is made from a 12-gauge smoothbore gun using flying saucers. Targets are thrown into the air by an automatic throwing machine.

Athlete personality

First of all, it should be understood that it will take a lot of time and constant practice to achieve high results. Working with weapons implies iron discipline, precision of reaction and composure. To prepare for a shot, it is important to develop stress tolerance. An experienced shooter knows how to overcome excitement and give out the utmost concentration and concentration. It also requires the ability to quickly assess the situation and make decisions. All these qualities form a strong-willed and reasonable personality with the makings of a leader.

Sports shooting is an interesting and fascinating discipline with many subtleties that cannot be revealed in one short article. Touch this world live by visiting at least one competition or trial lesson.

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