10 people dead after strep infections in 2017, Toronto Public Health confirms

After nine deaths in London, Ont., due to a group A streptococcus outbreak made national headlines, public health officials have confirmed to CBC Toronto that 10 people have died in this city in 2017 due to the same infection.

Deadly form of strep infection primarily strikes homeless people in shelters, experts say

Group A Streptococcus is a strain of bacteria that lives in many people's noses, mouths and skin but can become dangerous and cause severe illness if it enters a person's bloodstream (National Institute of Allergy and Infectious Diseases/Associated Press)

After nine deaths in London, Ont., due to a group A streptococcus outbreak made national headlines, public health officials have confirmed to CBC Toronto that 10 people have died in this city in 2017 due to the same infection. 

Toronto Public Health (TPH) says 115 cases of invasive, or aggressive, forms of the strep bacteria have struck since the beginning of the year; a figure that included an 18-month-long outbreak at Seaton House, one of the largest homeless shelters in Toronto.

Dr. Michael Finklestein, an associate medical officer of health for TPH, says in invasive strep cases, "the bacteria gets into places of the body where it's not normally found, places like your blood, the lining of your brain, your joints. And then it can cause serious illness."

The number of dead in Toronto is causing major worries among health professionals, just as health officials are also wrestling with the nine deaths reported in London over the last 18 months. 

Street nurse Cathy Crowe says she is 'shocked' by the number of strep A deaths in Toronto over the past year and questions response time by public health officials. (CBC)

While most people who get sick from strep will experience a fever and sore throat, serious infections can cause toxic shock syndrome or necrotizing fasciitis, or "flesh-eating" disease.

Finklestein noted that 2017's percentage of cases resulting in death, 11.5 per cent,  is "comparable" to the five year average of 13 per cent that TPH has tracked. 

How are people getting infected? 

Group A streptococcus is bacteria that is fairly common and lives in many people's noses and mouths. The Public Health Agency of Canada (PHAC) reports that it can spread easily and in virulent forms through open skin wounds, and also through intravenous drug use. 

Health professionals also note that a majority of the cases across the country are appearing in homeless shelters. These are places where overcrowding, transient populations and poorer hygienic standards are not uncommon, said street nurse Cathy Crowe. 

"It's shameful," Crowe said.

"If there had been a strep A outbreak at a high school, or a nursing home, or a daycare, anything like that, there would have been communication, alerts, speedier action."  

It's shameful.- Cathy Crowe, street nurse on response times to control group A strep outbreaks

PHAC said penicillin is the most common treatment but that if the infection is spread through skin wounds and results in flesh-eating disease, amputation of limbs is a common treatment.  

An 18-month-long outbreak

Toronto health officials battled a long strep A outbreak at Seaton House, a homeless shelter at the intersection of Gerrard and Jarvis Streets. 

Finklestein told CBC News the outbreak lasted for 19 months, from the beginning in March 2016 to the last known case in April. One person died from the infection during that time period and the outbreak was deemed officially over as of mid-October.

"It is very difficult to control when it gets into a particular closed population like a shelter, a hospital or long-term care," Finklestein added. 

Ontario Health Minister Eric Hoskins told reporters on Thursday that the province is working closely with local health regions and shelters to ensure the spread of infections is stopped. 

"[People living in shelters] are as deserving of the highest quality care as anyone in this society. But they do often form a particular group that is at risk, so we're working with them to eliminate that risk," Hoskins said.  

Finklestein recommends several steps to avoid infections: 

  • Constant hand-washing and high hygienic standards.
  • Keeping wounds bandaged and well-cared for.
  • Coughing or sneezing into tissues.
  • Seeking immediate medical attention if there is redness or swelling skin.
  • Avoid sharing drug paraphernalia.