500 Kauai children
undergo tests for
flesh-eating bacteria

Health officials want to know
if the kids are carriers of the disease
that has taken one life

By Helen Altonn
Star-Bulletin

More than 500 children on Kauai have been tested to see if they may be a reservoir for a strain of a flesh-eating bacteria that has killed one person.

First-, second- and third-graders were tested yesterday at Wilcox, Kapaa and Waimea Canyon Elementary Schools. Results are being analyzed at Wilcox Hospital.

Patrick Johnston, state Health Department spokesman, said the tests were prompted by increasing admissions at the hospital the past three months with strep A bacterial infections.

"This issue is not new for Kauai," he said. "This has been going on for three years every fall, an increase in these type of infections."

As a result, the Health Department and Centers for Disease Control in Atlanta got involved and tested adults on Kauai over the past three months, he said.

They found 41 people had been infected with a particular strain resulting in a symptom known as necrotizing fasciitis.

Dr. Paul V. Effler, state epidemiologist, pointed out there are more than 80 strains of strep A bacteria and tests show a "wide array of types on Kauai."

He said necrotizing fasciitis is a rare manifestation of the illness in which bacteria burrows through the skin and grows quickly, killing tissue.

But most group A infections are not flesh-eating, Effler said. "The vast majority of group A infections are minor skin infections or sore throats which resolve on their own."

Sometimes the infection may not even be apparent, he said.

In about two-thirds of cases, a patient has an underlying medical condition that predisposes them to severe illness, Effler said. Three of four adults identified with necrotizing fasciitis on Kauai had underlying medical conditions, Johnston said. One refused treatment for the infection and died; the other three recovered. One of the four, a woman, had no other medical problems, Johnston said.

"That's what caused us to say this requires further investigation, to get a better picture of what's going on on the island."

Bill Evslin, Kauai Medical Group president, said the outbreak appears to be ending. After 22 hospitalizations in October and 14 last month, he believes there is only one now.

A similar epidemic occurred on Kauai after Hurricane Iniki in 1992 and was gone by the end of November, he said.

Effler said people with strep A skin infections can recover completely with medical treatment. "Hygiene is key," he said. People should make sure wounds are clean with soap and water and they should see a doctor if they have an infection.

Effler said there has been an increase worldwide of invasive infections caused by group A strep over the past 10 years. "The challenge is to find out what is fueling those strep A infections."

A study in Minnesota indicated school kids were carriers of the bacteria, Johnston said.

That study was applied on Kauai, not only to determine if the schools are a reservoir for the bacteria, but to learn more about the disease, he said.

Children who test positive will be treated with antibiotics.

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Star-Bulletin writer Trish Moore
contributed to this report.