Second alert for invasive diseases

Wednesday, March 29, 2023

Following their February Public Health Communique, Queensland Health has issued a second communique highlighting the increased evidence of invasive diseases.

Case numbers for invasive group A Streptococcus (iGAS) remain higher than the 5-year average in Queensland for the first quarter of 2023.

The alert follows the identification of a new strain of Streptococcus pyogenes emm1 (M1UK). The strain has been documented as having emerged and expanded in the United Kingdom (UK) over the last decade, however its role in the current high levels of iGAS in children in the UK remains uncertain.

Recent genomic data suggests that of the emm1 iGAS infections in Australia, the majority are the M1UK clone.

Rates of influenza and respiratory syncytial virus (RSV) are also starting to increase in Queensland. The latest notifiable conditions report shows there were 786 lab confirmed influenza cases and 751 cases of RSV across the state in the week commencing 20 March 2023.

The latest figures bring the year-to-date totals to 4,283 and 3,771 respectively.

Respiratory viral infections, particularly influenza and RSV can increase susceptibility to invasive disease.

While the overall risk of severe invasive infection to the general population is low, some cohorts may be more at risk. These include Aboriginal and Torres Strait Islander people, the immunocompromised, people with a chronic disease, people who smoke, those institutionalised or living in overcrowded conditions, and the very young and very old.

There is also additional risk with iGAS for pregnant and post-partum women.

Clinicians should be alert for signs and symptoms of sepsis and invasive disease when evaluating patients with a compatible clinical illness.

Signs and symptoms of sepsis in an adult include a patient with a suspected infection combined with any of the following:

  • fever, chills, or low body temperature
  • tachypnoea
  • tachycardia
  • no or low urine output
  • nausea, vomiting, or diarrhoea
  • fatigue, confusion, or drowsiness
  • a lot of pain or they ‘feel worse than ever’.

For paediatric patients, clinicians should consider sepsis in a child with suspected infection and any one of these signs and symptoms:

  • parental concern
  • a lot of unexplained pain or very restless
  • cold extremities
  • blotchy, blue, or pale skin or a non-blanching rash
  • altered behaviour such as drowsiness, confusion, irritability or floppiness
  • working hard to breathe with tachypnoea and in infants: long pauses in breathing
  • tachycardia
  • seizures
  • reduced urine output; fewer wet nappies than usual
  • lactate >2.

Hypotension is also a late sign of sepsis in children.

Remember: trust your gut and just ask – could it be sepsis? Prompt recognition and management of sepsis saves lives.

For the management of suspected sepsis, clinicians should refer to the paediatric and adult sepsis pathways and urgently escalate concerns to a senior clinician for a prompt review. Treatment should involve blood culture sampling, early fluids and appropriate empiric antibiotics, as outlined in the antibiotic prescribing guidelines where these are included with the pathways.

To prevent invasive infection, patients should be encouraged to:

  • Ensure they are up to date with vaccinations (IPD, meningococcal) where available and recommended in accordance with the Queensland Immunisation Schedule. Respiratory viral infections can be precursors to invasive bacterial infection, it is also important for patients, especially those most at risk, to be up to date with recommended vaccinations and boosters to protect against COVID-19 and influenza.
  • Exercise good hand and respiratory hygiene and to stay home if they are sick.
  • Optimise their management of any chronic medical conditions and quit smoking.

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Last updated: 29 March 2023