Distinguishing viruses responsible for influenza-like illness
Are Deadly Strep Infections On The Rise? Here's What To Know
Japan has been experiencing a dramatic rise in cases of streptococcal toxic shock syndrome (STSS), according to the country's National Institute of Infectious Diseases (NIID) and as reported in the Japan Times.
In 2023, a record 941 cases of STSS were reported in Japan, outpacing the record 894 cases that occurred in 2019. So far this year, 517 cases have been documented in the country, with cases occurring in 45 of 47 of the country's prefectures.
This week, the Tokyo Metropolitan Government issued a warning to residents about the disease, as 88 cases have already occurred in the city since the beginning of the year -- more than half of last year's total number. Specific factors that are fueling the surge remain unknown. The mortality rate for STSS in Japan is 30%, according to the NIID.
Japan's health authorities are now urging people to take basic preventive measures to ward off infection with group A Streptococcus (GAS), the bacteria that causes STSS, such as hand-washing and appropriate wound care. Aside from STSS, GAS causes other invasive infections such as cellulitis, necrotizing fasciitis, and pneumonia.
Invasive GAS Infections in the U.S.
"We've had issues in the U.S. With this organism ... So we've been aware of this for some time now," George Diaz, MD, an infectious diseases specialist and division chief of medicine at Providence Regional Medical Center in Everett, Washington, told MedPage Today.
Diaz pointed to recent CDC data that showed a decrease in invasive GAS infections during the COVID-19 pandemic, most likely due to preventive measures, such as isolation and quarantining. "We believe there's a resurgence in cases after those sorts of measures have been relaxed," he said.
Overall, invasive GAS infections have been increasing in the U.S. Over the past decade, primarily in adults, and preliminary data from 2023 indicated that the number of invasive GAS infections reached a 20-year high. However, during the COVID pandemic, cases decreased by up to 25% compared with the years right before the pandemic, and infection numbers were especially low in children. In late 2022, that trend reversed, with invasive GAS infections increasing to levels higher than those seen in pre-pandemic years, particularly for children. In December 2022, the CDC issued a health advisory about recent increases in pediatric invasive GAS infections in multiple states.
CDC data from the last 5 years showed that approximately 14,000 to 25,000 cases of invasive GAS disease occurred each year in the U.S. And 1,500 to 2,300 people died annually from these infections. In contrast, several million cases of milder GAS-associated illnesses, such as strep throat, scarlet fever, and impetigo, occur annually in the U.S.
Diaz noted that the apparent spike in cases of STSS in Japan may be in part due to heightened vigilance in diagnosing the condition there. "It could be that what Japan is seeing is that they're being very careful about identifying these cases. And so they're seeing these high numbers, especially in mortality, versus in the U.S. Where we may not be quite as good as Japan in identifying and tracking these cases," he explained. It is not uncommon for milder forms of STSS to be underdiagnosed, he added.
STSS can result from invasive or noninvasive GAS infection, but typically occurs when bacteria enter through compromised skin or mucus membranes, with the main sites of entry being the vagina, pharynx, mucosa, and skin or soft tissue, and then spreads systemically and in the bloodstream. However, the route of entry remains unknown for up to 50% of cases.
Early symptoms of STSS include influenza-like symptoms, such as fever, myalgia, nausea, and vomiting. As the disease progresses, it is associated with soft tissue necrosis, as well as multi-organ involvement, including renal impairment, coagulopathies, liver involvement, and acute respiratory distress syndrome. Mortality rates from STSS range from 30% to 70%, even with aggressive antibiotic treatment and hospitalization.
STSS is more common in people ages 65 and older, those who have recently had surgery, and in people with diabetes or alcohol use disorder. GAS can be transmitted via droplets and contact with contaminated surfaces, but transmission can be reduced by standard infection control practices, including good hand hygiene and respiratory etiquette.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
Diaz reported no conflicts of interest.
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What's Going Around: Respiratory Viruses, Influenza, Pneumonia, Stomach Viruses
Here's our weekly round-up of what illnesses are spreading the most in Metro Detroit communities, according to our local doctors and hospitals.
Wayne County – Influenza, post-flu pneumonia, strep throat, asthma flare-ups, Covid, stomach virusesDr. Kevin Dazy -- Pediatrician at Children's Hospital of Michigan
"We're still seeing a good amount of flu, both influenza A and influenza B. We're also seeing a good bit of strep, along with lots of kids with asthma flares. Symptoms of strep include sore throat/throat pain, red swollen tonsils, fever and swollen lymph nodes in the neck."
Dr. Christopher Loewe -- Ascension St. John Hospital
"The biggest thing I'm seeing right now is Influenza. I'm seeing kids and adults with it along with a few severe cases of post-influenza pneumonia in kids. This is a reminder to rest and drink lots of fluids. Also, everyone should wash their hands frequently."
Dr. Jennifer Stephens-Hoyer -- Emergency Department, Henry Ford Medical Center Plymouth
"While COVID-19 rates have fallen a bit in the last month, cases are still popping up in the ED. And it seems, from the ED perspective, to be affecting the elderly most harshly. Influenza activity, specifically Influenza A, is at a high level in our area. Vaccination provides some protection, but breakthrough infections do still happen. So being mindful of others when you suspect or know you are ill may help quell spread."
Dr. Glen Clark -- Emergency Center Chief, Corewell Health's Beaumont Hospital Grosse Pointe
"We are seeing gastroenteritis, or the stomach flu, as well other viral illnesses. COVID and influenza cases are still being documented."
OAKLAND COUNTY – Stomach viruses, strep throat, influenza, Covid, RSVSarah Rauner, RN -- Chief nurse practitioner, Emergency Center and After Hours Pediatric Clinic, Corewell Health Beaumont Troy Hospital
"We have seen an increase in vomiting, diarrhea, with and without fevers. Strep throat has increased a bit lately. We are still seeing influenza and COVID with less RSV. Hopefully we are in the home stretch of back to back infections for school age children and younger."
Emergency Department, Henry Ford West Bloomfield Hospital
"We have had a lot of fever, respiratory issues and pain – mostly abdominal but chest pain as well. We had one case of measles on the weekend seen here in the ED."
Washtenaw County – Influenza, viral illnesses, Covid, spring allergies, asthma & COPD flare-upsDr. Brad Uren -- Clinical Associate Professor of Emergency Medicine, Michigan Medicine
"Less COVID and URIs generally this week. Not as much allergy/asthma/COPD this week."
Dr. Marisa Louie -- Medical Director of Children's Emergency Services, Michigan Medicine
"We are seeing a lot of influenza still, in addition to the usual mix of other viruses."
Washtenaw County Health Department
"Influenza cases in Washtenaw County residents are currently at high levels. Most Influenza cases being reported in Washtenaw County are Influenza A, types A(H1N1) and A(H3). Sporadic cases of Influenza B are being reported. Influenza-related deaths in Washtenaw County adults have been reported this flu season. All individuals were older adults with confirmed Influenza A infection. Flu-related hospitalizations of Washtenaw residents are currently at high levels."
Monroe County – Respiratory illnesses, influenza, pneumonia, strep throat, stomach virusesProMedica Monroe Regional Hospital – Emergency Center
"This week at ProMedica Monroe Regional Hospital we are seeing a lot of respiratory illnesses, including influenza A and B, pneumonia, and strep throat. We are also seeing a lot of gastrointestinal illnesses which includes symptoms of nausea, vomiting and diarrhea."
Macomb County – Strep throat, influenza, stomach virusesDr. Christopher Shamass -- Emergency physician at McLaren Macomb
"There has been a noticeable increase in pediatric patients diagnosed with strep throat, results in a sore, scratchy throat and a slight fever. Cases of influenza continue to be reported in significant volumes, with the majority of patients experiencing a persistent cough, fever, and body aches. Viral gastroenteritis remains a very common diagnosis, with patients experiencing nausea, vomiting, and diarrhea, which can lead to dehydration for many."
Dr. Maria Samuel -- Primary Care Physician, Henry Ford Medical Center Sterling Heights
"We are seeing flu and COVID-19 cases come down, but are still seeing more flu and some step cases too."
Livingston County -- Respiratory viruses, stomach virusesCopyright 2024 by WDIV ClickOnDetroit - All rights reserved.
Hampton Elementary School Student Dies From Group A Strep Meningitis
HAMPTON, Va. — A Francis Asbury Elementary School student died from meningitis, according to the school's principal.
The child had group A strep meningitis, according to Principal Liz Franks' statement.
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Franks informed Asbury Elementary families of the student's death on Monday night. The message that was shared with families is as follows:
Dear Asbury Fox families,
It is with great sadness that we share with you that one of our students has passed from streptococcalgroup A meningitis.
Please know the parents and guardians of the affected classroom have been directly notified and counselors will be in place to support students and staff as needed. It is not expected that teachers share this information with other students outside of the individual's class. However, if a student is upset or asks questions about this loss, we have asked our staff to talk individually with the student and send any student to the counselor as appropriate.
Parents/guardians who would like additional support for their child should contact our main office at 757-850-5075 between the hours of 7:30 a.M. To 1:30 p.M.
As we shared with our families last week, the risk of transmission of streptococcal group A meningitis within a classroom is considered low. Casual contact (as in work and school) rarely spreads the bacteria. As we also shared last week, as a precautionary measure and to minimize the risk of spreading germs, we implemented additional cleaning and disinfectant measures to our entire school building to include using hospital-grade disinfectant.
Symptoms of meningitis may include sudden high fever, severe headaches, neck stiffness, nausea, vomiting, sensitivity to light, and a rash. If you or your child has or does experience any of these symptoms, we strongly encourage you to seek prompt medical attention. Also, please inform the school nurse if your child has recently had strep throat, scarlet fever, or impetigo.
For your convenience, here is the link we provided last week that has additional information from the Virginia Department of Health on streptococcal (group A strep) - https://www.Vdh.Virginia.Gov/epidemiology/epidemiology-fact-sheets/streptococcus-disease-group-a/ [vdh.Virginia.Gov]
As always, thank you for your continuous support.
Sincerely,
Liz FranksPrincipal
CHKD Pediatrician Dr. Douglas Mitchell tells News 3 group A strep meningitis is rare. According to Dr. Mitchell, meningitis is an infection or inflammation of the meninges around the brain.
Symptons include headache, fever, bright light sensitivity, nausea, vomiting and a stiff neck.
"That's one of the tell-tale signs is the child is not able to bring their neck down to their chest at all, they stay stiff and don't want to move their neck at all," said Dr. Mitchell.
Dr. Mitchell said there are several causes of meningitis to include parasites, fungus, viruses, and bacteria. Bacterial meningitis can be spread through close contact, like sharing drinks or a straw or kissing.
"Hygiene is always important particularly as we look at hand washing, because we talk about close contact, these bacteria can persist for a period of time on hands, good hand washing is always a good idea," said Mitchell.
There are several vaccines out there to protect against meningitis, including the meningoccocal vaccine, given at age 11. It's required by Virginia schools before 7th grade, and it's given again at age 16. It protects against four strains.
According to Dr. Mitchell, there's another vaccine that protects against a fifth strain given in young adulthood, aimed towards college aged students.
Dr. Mitchell said there is no vaccine for group A strep meningitis, which is what the Hampton child died from.
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