It took just two days for one-year-old Jordan Sutherland to go from experiencing clinginess and a slight temperature to being in intensive care after surgery to remove flesh-eating bacteria from his neck, which had “swollen from ear to ear”, his mother recalls.
Jordan would not leave the Royal Children’s hospital in Melbourne for almost five weeks, after an infection with the common strep A bacteria developed into a disease known as “invasive strep A”.
Australia is experiencing an intense surge in cases of the disease in children, a study published in medical journal the Lancet Regional Health on Wednesday found. The study analysed data from the Paediatric Active Enhanced Disease Surveillance (PAEDS) Network, finding that between July 2018 and December 2022, three children died with complications from invasive strep A infection.
Over the same period, 280 paediatric patients aged under 18 were admitted to five major Australian paediatric hospitals in Victoria, Queensland, Western Australia and the Northern Territory with the infection, the study found.
Of these, 84 young patients experienced severe complications including toxic shock, amputation and flesh-eating, necrotising disease like Jordan experienced.
Jordan’s mum, Caitlyn Sutherland, rushed him to Frankston hospital in February after his mild symptoms that she had originally put down to teething progressed to swelling in the neck overnight. Until then, he had been playing and eating normally.
Doctors arranged for Jordan’s transfer to the Royal Children’s hospital in Melbourne the same day, where he was put on oxygen to help him breathe. He was diagnosed with invasive strep A, underwent blood transfusions, and underwent surgery to remove the toxic tissue from his neck which by now was purple. He would require further surgery to ensure all the tissue was removed, and skin grafts on his leg due to open wounds on his body. He remained in intensive care for 10 days before being transferred to a general ward.
“It was brutal, he was just so lifeless and was on so many medications, and had all of these pumps attached to him in intensive care, and some of the medicines leaked and left wounds on his leg,” Sutherland said.
“We were told by the doctors initially that he was walking on a tightrope and they weren’t sure if he was going to make it. The surgeons said his tonsils were black, and they said the infection in the neck had entered through the tonsils. Earlier that day, doctors said his tonsils were ‘just a bit red’. I can’t believe how quickly it turned into something so horrible.”
Now 18 months old, Jordan has fully recovered and is “constantly trying to keep up with his big brothers”, Sutherland said. But over the past few months he has required frequent checkups, dressing changes and monitoring for infection in his wounds. It wasn’t until May that his parents felt they were “out of the woods”. It took him weeks to be able to walk again, with rehabilitation work required, and he still receives ongoing check-ups.
Infections with strep A bacteria are common in childhood, usually causing short and minor illnesses treatable with antibiotics. The bacteria are usually spread through close contact with someone infected through sneezing or coughing, or with contact with an infected wound. But in seemingly random, rare cases, infection with strep A can cause a severe form of illness known as invasive strep A, which can lead to complications including death, sepsis, amputations and tissue damage.
Though still rare, the incidence of invasive strep A has risen from 3.7 cases per 100,000 children in Australia in 2018, to 5.2 per 100,000 children in the third quarter of 2022, the Lancet Regional Health study found. There were 23 cases in children in 2020, compared to 107 in 2022.
It has prompted paediatric infectious diseases physicians to call for increased funding and urgency towards a strep A vaccine, with young children, elderly people, pregnant women and Indigenous Australians particularly susceptible to complications.
Dr Yara-Natalie Abo, from the Murdoch Children’s Research Institute, led the study and said despite differences in seasons and circulating viruses, Australia’s case surge has been similar to that seen in the northern hemisphere.
“Increases in strep A cases have been reported around the world, occurring during, and outside of, typical spring peaks,” she said.
A co-author of the paper, Prof Andrew Steer, said there were several promising strep A vaccine candidates in early stages of clinical trials.
“But one of the key barriers, clearly, has been funding in the field,” he said. Steer said while the federal government gave $35m to the Australian Strep A Vaccine Initiative in 2019, the findings from the study reveal why further funding to “fast track development is really important”.
The study also provided important insights into the difficulties some parents faced in seeking care and diagnosis for their child because of the non-specific symptoms. In the seven days prior to hospital admission, 187 of the young patients had seen a doctor. Of these, 130 consulted a GP, 118 an emergency department physician and 61 had seen both.
The most common diagnosis at the first consult was an unspecified viral illness. Once children developed more severe symptoms and were admitted to hospital, the most common symptom was fever (89% of patients) and 41% of patients had a sunburn-like rash. Many also reported limb-pain.
Associate Prof Asha Bowen, a paediatric infectious diseases specialist and researcher with the Telethon Kids Institute in Western Australia, was involved in the process of strep A becoming a nationally notifiable disease in 2021. She said if parents feel their child’s symptoms change or they are worried then “it’s our job as clinicians to make sure we’re listening out for that and are paying attention, and ensure families always know that they can come back if the situation may change”.
“I work at Perth Children’s hospital, and we have really been profoundly impacted by the devastatingly sad passing of Aishwarya Aswath in 2021 from invasive group A strep, and the way we respond to cases has profoundly changed, including the way we’re responding to parents,” Bowen said.
“There are a host of different ways that strep A can cause disease in children and invasive strep A is the most frightening one, and unfortunately it looks like a normal illness until it suddenly doesn’t. Children suddenly become crushingly unwell and in intensive care, taking families as well as clinicians by surprise.”
She agrees a vaccine is crucial to prevent the disease, which is particularly devastating remote Aboriginal communities in northern Australia. In Aboriginal children, strep A can cause rheumatic heart disease, leading to death, or severe complications requiring open heart surgery.
But Bowen said funding aside, there were numerous challenges presented by the bacteria that make vaccine development tougher than for some other diseases.
One of them, she said, “is that strep A can cause anything from common sore throats and skin sores, all the way through to these very severe, rare invasive group A infections where the heart and kidney can be damaged because the immune system goes into overdrive mounting a response to it,” Bowen said.
“We don’t want a vaccine to trigger this severe, unwanted immune response, and that has been one of the challenges in vaccine development.”
Bowen co-authored a paper published in the Medical Journal of Australia on Tuesday which presented a number of hypotheses for the rise in invasive strep A. Bowen told Guardian Australia they include that a new strain may be implicated; that other respiratory infections are leaving some people susceptible to invasive strep A; or that hygiene practices during the pandemic depleted resistance to the bacteria.
The paper included nationally invasive strep A notification data across all age groups, revealing there were 1,180 cases in 2022. The Australian total for 2023 up to 20 July was 1,185, the paper said.
• This article was amended on 25 August 2023 to clarify that the hypothesis that hygiene practices during the pandemic may have depleted resistance to the bacteria was mentioned in an interview with the Guardian, rather than in the paper co-authored by Bowen.
