By STEFAN VERBANO
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The Hawaii Department of Health is investigating reports of high rates of a dangerous bacterial infection in West Hawaii.

DOH is working with the Hawaii District Health Office and Centers for Disease Control and Prevention to follow up on physician findings of above-average cases of invasive Group A Streptococcus (iGAS) — caused by a bacteria commonly found on the skin or in the nose that doesn’t normally lead to infection.

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A higher-than-normal caseload over a period of several months was noted by a local West Hawaii epidemiologist, who reported the worrying trend to DOH. Conditions responsible for the spike in illnesses brought on by the bacteria are not yet known, according to the department.

Due to the ongoing nature of the investigation, DOH officials declined to provide the number of patients affected or their specific locations.

The pathogen becomes “invasive” when it enters parts of the body that are normally sterile, like the blood, deep tissue, muscles or lungs through broken skin or mucous membranes and overwhelms the body’s immune defenses.

This can lead to severe, life-threatening conditions like necrotizing fasciitis, commonly known as “flesh-eating disease,” and Streptococcal Toxic Shock Syndrome, where severe immune responses lead to fever, low blood pressure, organ failure and skin breakdown. These complications often require immediate ICU care as their mortality rates can be excessive.

In the last five years in the U.S., reported cases of iGAS ranged from 20,000 to 27,000, with approximately 2,000 deaths on average annually. This represents a mortality rate of around 1 in 10 — a lethality considered high by epidemiologists and public health officials.

Even so, according to DOH the “overall risk to the public is low.” The department stipulates that awareness and early treatment, typically with antibiotics, is critical in preventing infections from rapidly becoming severe illness.

It’s possible that Hawaii Island’s climate — providing ideal conditions for bacterial growth — is playing a role in the disease’s spike.

“It could be part of the reason why… it’s a wetter, warmer climate here,” said Emily Klann, an epidemiological specialist for the Hawaii District Health Office. “I think that the climate definitely could be involved, and that’s another reason why we are investigating and looking at potential risk factors including the climate of where these people normally reside in the area.”

The DOH investigation seeks to identify other potential environmental factors contributing to the rise in cases so that health officials can develop more effective prevention measures.

“There definitely could be some risk factors that are specific to this area, and identifying those through an investigation like this would help the physicians, the medical providers, as well as community members,” Klann said. “They can use that information to better protect the public and protect themselves against these types of infections.”

At highest risk of iGAS complications are older adults and those with medical conditions like diabetes, cancer and heart, kidney and respiratory diseases. People with compromised immune systems, open wounds or skin infections — including homeless individuals and injection drug users — might also be at increased risk.

Additionally, recent viral infections like chickenpox and influenza can increase the likelihood of complications.

“Another reason (for the investigation) is to understand the burden of this disease and who’s most affected by it,” said Alden Henderson, a DOH epidemiologist based on Oahu.

Until the results of the investigation are analyzed, DOH guidelines on prevention involve basic hygiene and first aid for wound care.

“One of the goals is to identify potential risk factors so that we can do better preventive messaging more specific to the local community,” Klann said. “But at this point it’s just kind of general … keeping wounds clean and covered, hand-washing and seeking medical attention if it looks like a wound might be infected. Early medical attention is important.”

Email Stefan Verbano at stefan.verbano@hawaiitribune-herald.com.