necrotizing fasciitis outbreak in Southern Ontario

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Parents beware

Chickenpox has become a gateway for flesh-eating disease and Southern Ontario is a hotbedBy JAN WONGSaturday, October 4, 2003 - Page M1

OAKVILLE, ONT. -- It was Saturday in suburbia. Watt, 6, had a soccer game. His sister, , 3, had chickenpox. She also had a high fever and couldn't walk. While 's mother took her to emergency, 's father took him to the game.

"Do me a favour,'' Doug Watt, the head coach, said to the assistant coach. Could he gather up the net and balls? Mr. Watt explained that he had to scoot to the hospital right after the game.

"What's up?'' the assistant coach asked. Mr. Watt described his daughter's symptoms.

"I don't want to scare you,'' said the assistant coach, "but I think this potentially could be necrotizing fasciitis.'' Mr. Watt, a marketing executive, had no idea what the man was talking about. To humour him, Mr. Watt asked what necro-whatever was.

"Flesh-eating disease,'' said Dr. Bain.

For reasons no one completely understands, chickenpox has suddenly become the main gateway in children for this potentially fatal disease, in which extra-strength bacteria literally consume human flesh. "Chickenpox is a huge risk factor for necrotizing fasciitis,'' says Dr. Low, chief microbiologist at Toronto's Mount Sinai Hospital, who monitors the double whammy for Ontario. "Coming mid-October, we start getting phone calls about new cases.''

If that weren't terrifying enough news for parents, flesh-eating disease clusters -- with both adult and child victims -- have been popping up across the province in recent years, in Barrie and along Lake Ontario from Toronto to Niagara, hitting Kitchener-Waterloo, Brantford, Oakville and Burlington, in no particular order. It's a phenomenon doctors can't yet explain. In Ontario, the incidence of flesh-eating disease in the population as a whole increased four-fold from 1992 to 1996, according to a study co-authored by Dr. Low. Currently, the province averages 25 to 30 cases a year, he says.

The chickenpox/flesh-eating disease combination is so new, Health Canada only began national surveillance of it in 2000. No comprehensive data is yet available. Indeed, Canadian researchers published the first scientific study linking the two only in 2000.

Currently, about 400,000 children contract chickenpox in Canada each year. Of these, 2,000 will be hospitalized for complications. Half of these will involve infections caused by group A Streptococcus, the bacteria that can lead to flesh-eating disease.

At Toronto's Hospital for Sick Children, about 40 to 80 kids are hospitalized for complications from chickenpox each year, including flesh-eating disease. "Chickenpox increases the risk of Strep A infection 40- to 60-fold in healthy children,'' says Dr. Lee Ford-, an infectious disease specialist there who personally handled three such cases in August alone. That compares with an average of three cases per year from 1985 to 1991.

A decade ago, the combination was quite rare. "The first case I ever saw was in December, 1994," says Dr. Ross Pennie, a pediatrician who helped treat and is considered the guru of flesh-eating disease in Ontario. At McMaster Children's Hospital, he says, "we were seeing one case every two weeks in winter."

Flesh-eating disease follows chickenpox for three reasons, doctors say. Children, the prime targets of chickenpox, are also carriers of Strep A bacteria, mostly in their throats. Second, the average case of chickenpox produces 400 lesions -- open windows through which the bacteria easily invade the body. Third, a bout of chickenpox may hijack the immune system, making the child vulnerable to Strep A.

Since 2000, researchers have tracked admissions of children with severe chickenpox complications at 12 hospitals across Canada. Of 940 young patients recorded between 2000 and 2002, nine suffered strokes.

Eleven other children had flesh-eating disease requiring disfiguring surgery, according to Dr. Scheifele, director of the vaccination evaluation centre at B.C.'s Children's Hospital in Vancouver. His latest case involved a little girl with a pox lesion on her vulva. The surgery involved removing the skin of her genitalia. "It's like a reverse lottery,'' he says. "Once in a while your child will lose big time.''

The shame, doctors say, is that chickenpox is no longer inevitable. While there is no vaccine for flesh-eating disease, there is a very good one for chickenpox. A single dose, enough to immunize a child for life, costs doctors $58 and retails at pharmacies for $60 or $80, depending on the mark-up. (Children age 13 and over require two doses.)

In December 1998, the federal government approved use of the varicella virus vaccine. In May 1999, an eminent group of scientists on the National Advisory Committee on Immunization recommended every child be vaccinated at 12 months of age.

Dr. Pennie, who transferred to Brantford General Hospital last July, has lobbied the government in vain to pay for the vaccine. Unfortunately, more than half the provinces and territories won't, including Ontario, Quebec and B.C.

Many parents reflexively assume that if it were important, the government would pay. So they won't either. "People with SUVs will spend $70 to gas up their cars, but won't come across for $70 for their kids,'' says Dr. Pennie.

Ontario would need to spend $9-million a year to inoculate children, compared with an unknown cost for doctors' visits, hospitalization, intensive care and multiple surgeries. "And how many days off work would you need if your kid had a leg amputated?'' says Dr. Mills, a family doctor in Burlington. "It's a no-brainer. For $80, you can buy three cases of beer, or one immunization and give your kids life-long immunity.'' Without the vaccine, about 150,000 children get chickenpox in Ontario each year