The apparent transmission of invasive group A streptococcal (iGAS) disease at Spul-u-Kwuks elementary in March has prompted health authorities to review whether students should be notified immediately if a classmate falls ill with the rare infection.
“The first step is we need to be notified if there’s just one case of invasive strep A case confirmed,” said Sam Chen, whose son John, a Grade 5 Spul-u-Kwuks student, remains in hospital after iGAS caused flesh eating disease (necrotizing fasciitis), resulting in immense loss of muscle mass.
“My son will be in a wheelchair, well, we don’t know how long,” said a somber Chen, who continues to fundraise to ease the family’s financial burden for what lies ahead.
The B.C. Centre for Disease Control (BCCDC) suspects John contracted the bacteria at school, although it’s uncertain exactly how it happened, said Chen.
This would be the first known school transmission in B.C. Meanwhile, provincial health authorities are simultaneously seeking answers to a steady rise of iGAS in B.C.
A week before John was admitted to hospital, another student contracted iGAS and was hospitalized with other complications (streptococcal bacteria is fairly common, but when it becomes invasive in blood, muscles and tissues, it can cause various serious conditions).
Vancouver Coastal Health (VCH) did not send out notices to parents until John became ill. That’s because transmission at a B.C. school had never happened before. Chen thinks if an initial notice had been sent out, he would have considered John’s fever, sore throat and body pains to be an emergency. Instead, he took John to a medical clinic and a doctor prescribed ibuprofen and bed rest. Two days later John was being rushed into surgery at B.C. Children’s Hospital.
Medical Health Officer Dr. Althea Hayden said VCH will review its notification policy.
“We would have no reason to think elementary classmates would be at increased risk of developing a case of invasive group A strep,” said Hayden.
After John’s case was reported, VCH dispatched notices to the school and issued antibiotics to classmates, treating it as an outbreak, said Hayden.
Normally, notices and antibiotics are only issued to people in close contact, such as parents or, in the case of daycares, childcare workers and toddlers.
Prior to John’s case, VCH drew the line at school, because there was never such a case. Now, VCH will review that line. But Hayden noted health authorities must still balance the risks and benefits of notifying members of the public. Risks include unwarranted worry and panic, patient confidentiality and, importantly, the risks of needlessly taking preventative antibiotics. She stressed that not notifying schools after one case was “not a workload-based decision” and VCH already has one of the most comprehensive notification policies in the developed world.
“A severe disease like this in children is quite unusual,” said Hayden, who said medical staff close to John are heartbroken.
Also heartbroken is Trustee Sandra Nixon, who, given the new realities, now favours notification to schools after one case.
“It may still be uncommon for Strep A to be spread among classmates; however in my opinion, we need to err on the side of caution as even one case is one too many. So I agree VCH should be looking into a change to the protocols, and in particular, to the communication protocols, including immediate notification for parents when the first case is diagnosed in the school,” said Nixon, the Richmond Board of Education’s liaison with VCH.
Dr. Monika Naus of the BCCDC told the Richmond News that 2016 had the most cases of iGAS (303) since record keeping began in 1997 and that 2017 is on pace to set a new record.
Naus said good hygiene is the best preventative measure.
“Cough into your elbow, wash your hands and use alcohol gels,” said Naus.
To help the Chen family, see GoFundMe.com/John-Chen-MedicalFund.
