November 2016


GAS is a germ (bacterium) that is commonly found in the nose, throat and/or on the skin. GAS can be present in any of these places and not cause symptoms of illness, but it can also cause disease that ranges from mild to severe.

Signs and Symptoms

Symptoms that may indicate severe invasive GAS include:

  • Necrotizing fasciitis and myositis: fever, severe pain, swelling and/or redness of part of the body
  • Meningitis: fever, severe pain on movement of the neck, nausea, and or vomiting
  • Streptococcal toxic shock syndrome: fever, a general feeling of being unwell, dizziness, confusion and/or a flat, red rash on the body

Complications (That May Arise)

If people with GAS get infections, they most commonly develop a sore (strep) throat, tonsillitis, or skin infections (e.g., impetigo, pyoderma). GAS is sometimes found in unusual places such as blood, fluid surrounding the brain and spinal cord, or in the lining of muscles and joints.  GAS found in these unusual places is called “invasive disease” and can result in severe invasive GAS disease.

Risk Factors

Few people who come in contact with GAS bacteria will develop disease. Breaks in the skin, such as cuts or wounds may provide an opportunity for GAS to enter the body.  Although healthy people can develop invasive GAS, those with chronic illnesses such as HIV, cancer, diabetes, heart disease, lung disease, injection drug users, heavy alcohol users, and those taking steroid medications are at higher risk. Close contacts of people with invasive GAS may be at increased risk of infection; however, the risk of infection is low.


Good hygiene, and improved general infection prevention practices may prevent the transmission of GAS. While achieving all the recommendations noted below may not be possible in many circumstances, each small change contributes to making a difference.

Shelter/homeless/under-housed clients should be encouraged to:

  • Wash hands frequently with soap and water, or use alcohol-based hand sanitizers if hands are not visibly dirty (e.g., after using the bathroom, before meals, after coughing into a hand or blowing a nose); generally, everyone should wash their hands at least 5 times daily.
  • Cover a cough or sneeze with a sleeve or tissue.
  • Ensure prompt attention to wounds or cuts to avoid infection. Wounds should be regularly assessed and covered with a bandage or dressing until healed. Infected wounds (e.g., red, swollen, painful, draining pus), should be assessed by a health care provider as soon as possible.
  • Bathe regularly.
  • Wash clothing regularly.
  • Avoid sharing personal care items, such as bar soap, toothbrushes, razors/shavers, combs/brushes, clothing or towels;
  • Avoid sharing food, drinks, plates or utensils.
  • Avoid sharing cigarettes.
  • Avoid sharing injection drug use equipment (e.g., needles, cookers, water, filters, tourniquets) and items used to smoke or snort drugs (e.g., crack pipes, straws).
  • Seek prompt treatment for lice, bed bugs or itchy skin. Bed bugs and lice can irritate the skin leading to scratching which may cause breaks in the skin.

In addition, staff working in shelters and drop-in centres should ensure that:

  • Hand washing sinks are conveniently located and accessible for residents and staff. If appropriate, alcohol-based hand sanitizers may also be used for routine hand hygiene if hands are not visibly soiled. Dispensers should be accessible with an alcohol content of 70% to 90%. Note that hand sanitizers that are not alcohol based are not effective and cannot be used to replace alcohol hand sanitizers or soap and water.
  • Environmental cleaning and disinfection is performed on a routine and consistent basis. Staff should have a cleaning schedule which should clearly identify who is to clean what and when. In particular, bathrooms need to be regularly cleaned, and shared equipment (e.g., shower chairs) must be disinfected between clients.
  • Damaged furniture or pieces made of fabric and seams should be avoided or discarded as they cannot be properly cleaned or disinfected.
  • The shelter environment is regularly decluttered to make it easier to clean.
  • Each client stores their personal care items (e.g., razors, soap, combs) in a kit designated for that client only
  • Pest control is regularly reviewed and appropriate measures are in place to reduce pests.
  • Clients are provided with access to harm reduction supplies (e.g. needles, mouthpieces for crack pipes, etc.) to reduce the risk of infection when using drugs. More information about accessing these supplies can be found on the TPH website, The Works, which includes a map of harm reduction supply locations.
  • If clinical services are being provided, follow the Provincial Infectious Diseases Advisory Committee’s Infection Prevention and Control for Clinical Office Practice best practice document.


GAS can spread through direct contact with secretions from the nose or throat of people who are infected (e.g. open mouth kissing or mouth to mouth resuscitation) or through contact with infected wounds or sores on the skin.  Individuals who are ill with GAS are the most likely to spread it to others.  People who carry the bacteria but have no symptoms are much less contagious. Treating an infected person with an antibiotic for 24 hours or longer generally stops their ability to spread the bacteria.

More Information

Call Toronto Public Health at 416-338-7600 (TTY at 416-392-0658) or speak to your healthcare provider.