Group A Streptococcal Infections

What are Group A Streptococcal Infections?

Group A Streptococcus (GAS) is a common bacteria regularly found in the throat and skin. Most infections caused by these bacteria are mild and include illnesses such as strep throat, tonsillitis, impetigo and cellulitis (skin infection).

However, in rare instances, an infection can lead to a more severe disease called invasive Group A Streptococcal (iGAS). This is a type of infection when bacteria get into parts of the body where they are not usually found, such as in the blood, joints, deep muscles or tissues, or lungs. Invasive Group A Streptococcal disease is rare but there are cases in Nova Scotia every year.

What are the signs and symptoms of common Group A Strep Infections?

Early signs and symptoms of strep throat:

• sore throat and neck pain
• fever
• rash or a skin infection that is red, swollen, warm and tender to the touch
• white discharge on the tonsil (inside the mouth) 
• swollen lymph nodes in the neck

Often people do not have a cough.

A sore throat doesn’t always mean strep throat - viruses can also cause sore throats.

Symptoms can develop rapidly and worsen very quickly in invasive disease. It is important to seek medical attention if you/your child start developing these symptoms.

How do I know if my child has iGAS?*

Children with iGAS have a fever and are ill. You should seek medical care if their child has:

Change in behaviour: Behaviour changes include being less alert, being confused or drowsy, not responding as usual, or having unusual movements or unusual speech.

Change in breathing: Breathing changes include fast breathing, difficulty speaking and breathlessness.

Dehydration: If your child is not drinking enough, has frequent vomiting or diarrhea, appears weak or is urinating less than every 8 hours.

Change in skin tone or colour: Children with cold clammy skin, blue lips, gray skin colour or purple blotches.

A rapidly spreading rash with or without severe pain or swelling: This can be a sign of iGAS infection in skin and muscle.

Rapid progression of their symptoms even if they were recently assessed by a health-care provider and even if they were already started on an oral antibiotic.

Fever that has lasted for 5 days: Children with persistent fevers should be assessed by a health-care provider during their illness, whereas children with weakened immune systems or infants under 3 months of age should be seen at the onset of fever.

How is GAS spread?

• GAS bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected (for example kissing, sharing cigarettes or vaping devices).
• GAS bacteria can also be spread through contact with infected wounds or sores on the skin.
• People who are sick with GAS (i.e., strep throat, skin infection, etc.) are most likely to spread the GAS bacteria to others. People who carry the bacteria but have no symptoms are much less contagious. 
• Most people who come into contact with the bacteria will not get symptoms or only get mild throat or skin infections.

Who is most at risk of getting invasive GAS?

Very few people who come in contact with GAS bacteria will develop invasive GAS disease. Although healthy people can get invasive GAS disease, those at higher risk include:

• the elderly
• infants
• people living in a group-settings
• people with chronic illnesses like cancer, heart disease, lung disease, diabetes and kidney dialysis and those taking medications that can suppress the immune system.

How is a GAS infection treated?

All Group A Streptococcal infections can be treated with antibiotics. Early treatment can prevent complications. With proper antibiotic treatment, a person can stop being contagious within 24 hours. However, it is important to complete the entire antibiotic treatment as ordered by your health care provider.

My child was diagnosed with strep throat. Will they get iGAS?*

Children with strep throat do not appear to be at higher risk of developing iGAS. While it is the same bacteria that causes strep throat and iGAS, there are many different strains, or sub-types, of group A Streptococcus. Only certain strains cause invasive disease, and they may be different from the ones that cause common strep infections.

How can a GAS infection (invasive) be prevented?

While there is no vaccine to prevent group A streptococcal infections, there are things you can do to prevent illness in general including:

• Wash hands regularly with soap and warm water.
• Clean wounds and watch for signs of infection.
• Make sure you are up-to-date on your influenza, COVID-19 and varicella (chickenpox) vaccines if eligible. Invasive Group A Streptococcal can occur when people have another virus. Learn more about immunizations. 
• Stay home when sick to prevent the further spread of illness.

What is the Public Health response?

As standard practice with all communicable diseases, Public Health quickly identifies all possible close contacts of anyone who is confirmed to have iGAS and follows up with them directly to assess their potential exposure to the infection. Those who may have had significant contact with the individual would be offered antibiotics prophylaxis (preventative treatment) to help stop the infection from occurring.

For more information, please contact your healthcare provider, 811 or your local Public Health Office.