First effort failed to stop outbreak at Toronto shelter

Testing and treatment of residents at the men’s homeless shelter seemed to be working until more cases in June.
Toronto Public Health thought in May it had tamed the group-A strep outbreak at Seaton House shelter that has sickened 37 people, but was forced to call outside experts when the bacteria roared back.
Health officials are still fighting the March-declared outbreak, and awaiting the results of more than 170 throat swab tests conducted over the weekend on expert advice after more limited testing and treatment failed to halt the bug.
The outbreak hospitalized five residents of the George St. homeless shelter who were sickened by the potentially deadly “invasive” strain. One died from other medical causes, says TPH’s Dr. Michael Finkelstein.
Finkelstein said efforts to stop the spread of group-A strep in April and May, including testing over weeks of some people in the shelter, appeared to be having results, until a cluster of new cases appeared in June.
People can carry group-A streptococcus in their throat or on skin without knowing it. Other “superficial” infections, including strep throat, fever and skin infections, have been suffered by 30 shelter residents and two staff.
Group-A strep is usually transmitted through mucus or spit by people in close quarters. Nursing homes and army boot camps have seen outbreaks.
TPH called infectious disease experts Dr. Alison McGeer of Toronto’s Mount Sinai Hospital and Dr. Edward Kaplan of the University of Minnesota.
They advised testing more people over a much shorter period to get a handle on who needs treatment, because the disease likely spread during the earlier effort.
Residents of the third and fourth floors, where officials have tried to contain the infection, were swabbed, along with those who come in contact with them. Those who test positive will get antibiotics.
“In the first go, you minimize the risk of antibiotic side effects and the cost of screening people,” and that’s often enough to stamp out the bug, McGeer said. “That failed so you go to the second level, to wide-scale testing that is resource intensive and more expensive but should halt the outbreak.”
It might be two to three months before public health knows if new efforts, which include more hand-washing and increased attempts to prevent and treat skin breaks, have finally stamped out the bug.
Kaplan, speaking from New York City, lauded public health’s efforts.
“I don’t think anybody has made quote-unquote mistakes. Who knows that the first case represents the beginning of an outbreak?”
But Cathy Crowe, a renowned Toronto street nurse and homeless advocate, said the city did not cast a wide enough net in alerting social service agencies about the outbreak.
“There is no geographic barrier at Seaton House, there’s a lot of fluidity in movement with people coming and going,” Crowe said, adding she learned of the outbreak by word of mouth and not a public health email chain she monitors.
“We could have started talking back in March about how to stop this outbreak but now we’ve got a lot of unknowns, to many of us, including the ages and health status of the people infected.”