Ontario's medical officer of health will be putting out an official alert to the province's doctors, notifying them about what appears to be Canada's first case of a multi-drug resistant meningitis, Â鶹´«Ã½ has learned.
The alert will be issued as concern grows over the condition of a Toronto toddler being treated for meningitis caused by a new sub-strain of Streptococcus pneumoniae 19A.
It's an emerging antibiotic-resistant "superbug" that has caused dozens of ear infections in Massachusetts and New York State -- prompting the U.S. Centers for Disease Control and Prevention to start tracking the new strain.
Doctors suspect this super-strain is circulating in Ontario, and perhaps other parts of Canada, which is why they want to track it and alert other physicians to watch for it. The alert isn't designed to alarm, rather to inform doctors to keep an eye out for cases such as ear infections that don't clear up with the usual antibiotics.
"We'll be notifying the other public health agencies in Canada and we'll be notifying them that we have this in Ontario," Dr. David Williams, Ontario's chief medical officer of health, told Â鶹´«Ã½.
The unidentified toddler has been receiving care at the Hospital for Sick Children in Toronto for more than two weeks. Doctors say it took them less than 48 hours after admission to figure out that the child had somehow picked up the newly identified strain of 19A.
The child had been treated in the intensive care unit but is now in a ward room, continuing to battle the infection, hospital officials say. The child is being treated with antibiotics normally reserved for adults, after a litany of antibiotics for children proved ineffective.
Hospital officials stress that the otherwise healthy child acquired the infection in the community -- not in hospital.
Dr. Williams says it's still not known how the case emerged, since it appears the infected toddler had not traveled out of province before becoming ill.
After trying numerous antibiotics approved for children, doctors eventually turned to the adult-approved drugs levofloxicin, vancomycin, telithromycin and rifampin, all of which appear to be effectively treating the illness. But the child is still quite ill, says SickKids official Dr. Upton Allen, and treatment is continuing.
S. pneumonia is not new in Canada. It causes hundreds of chest and throat infections and ear infections each year. In rare cases, it triggers pneumonia and meningitis, illnesses that are usually easily treated with antibiotics.
The 19A strain is not new either. But doctors say this new subtype of 19A can't be killed off with any of the antibiotics approved for use in children.
"The big issue with this particular strain is that it's multi-drug resistant," Dr. Susan Poutanen, an infectious disease consultant at Toronto's Mount Sinai Hospital, told Â鶹´«Ã½net.
"It doesn't necessarily look like it's any more aggressive than other Streptococcus pneumoniae family members, but it's certainly more resistant and difficult to treat."
Dr. Michael Pichichero, a professor of microbiology, immunology and pediatrics at the University of Rochester Medical Center, was the first to identify the new 19A super-strain while he was treating children whose ear infections wouldn't clear up.
In October, he published a report in the Journal of the American Medical Association, describing his experience with the superbug. He tried 18 antibiotics approved in the U.S. for children and found that the only drug that worked was levofloxacin (also called Levaquin).
For one child, the cure came too late; the infection led to permanent hearing loss.
Pichichero's team believes the new sub-strain was most likely created by a combination of the superbug's ability to evolve quickly and the over-prescribing of antibiotics, which has led to antibiotic resistance.
19A not covered by Prevnar
The child being treated at SickKids had received all the vaccinations recommended for children, including Prevnar, which offers protection against seven strains of S. pneumoniae.
Since the introduction of Prevnar in 2000, the incidence of pneumonia and meningitis caused by pneumococcus has fallen by at least 69 per cent. As well, difficult-to-treat ear infections have been reduced by 24 per cent.
But Prevnar does not include the 19A strain, nor this new 19A sub-strain, and offers no protection against it.
The makers of Prevnar are reportedly aware that the vaccine needs to include 19A and are reformulating their vaccine. Other vaccine makers are working on other formulations that are still being tested. But it will take two years for a new vaccine to be approved and placed on the market.
In the meantime, doctors are being advised to be aware of this new drug-resistant strain of 19A, and to take action if a patient has a pneumococcal infection that isn't resolving -- such as an ear infection that defies treatment.
What parents should know
Infectious disease expert Dr. Neil Rau told CTV's Canada AM Thursday that, for now, he is not concerned about this new superbug, since this appears to be the first case of an extremely drug-resistant strain causing such a serious infection. But he will watching to see what develops.
"The strain 19A in and of itself is a concern because it's not covered by the vaccine, and if it's really resistant to antibiotics, as this particular clone is... and if we have a lot of that around, we have a bigger concern," he said.
Dr. Allen says it's important that doctors and health officials closely monitor this bug.
"If one doesn't have an appropriate monitoring system... one could find that the strains that are eliminated by the (Prevnar) vaccine are basically eliminated and are quietly replaced by other strains that can cause severe disease."
Dr. Poutanen says ear infections in children are quite prevalent, but it's when the symptoms persist that there is cause for concern.
"Often what will happen is symptoms will go away by themselves because it was a viral infection and the body takes care of it," Putanen told Newsnet.
"It's only if you're given an antibiotic prescription and you're following it properly, and if those symptoms continue to persist, that you'd have to worry you might have this particular strain."
With a report by CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
