The Epidemiology of Streptococcal Infections

Abstract

The typing of scarlatinal streptococci.-From the mass of conflicting claims of the specificity of the agglutinative reactions of hemolytic streptococci from various infections, we have concentrated on the work of Smith [5] and Griffith [6, 7], who described a serological classification of homolytic streptococci, obtained from cases of scarlet fever. Griffith described four main serological types of scarlatinal streptococci, constantly associated with cases of scarlet fever, and during the past five years I have used his methods and technique, with slight modifications, in the study with my colleague, Dr. W. Gunn, of haemolytic streptococci from scarlet fever and other infections due to, or associated with, these organisms. The value of this method of investigating hwmolytic streptococci from scarlet fever is seen in the following instances:(1) The ready identification of the great majority of strains as scarlatinal.(2) The identification of the same type (a) as the infecting agent when scarlet fever occurs in more than one member of the same family, (b) as the cause of an outbreak in a diphtheria or measles ward, or (c) as an epidemic in a public school as shown recently by Glover and Griffith [8].(3) The correlation between infecting type and the clinical severity of the disease.(4) The prevalence of a particular type, indicating the mildness or severity of an epidemic.(5) The relation between strains found in secondary attacks to those isolated during the primary infection.(6) The quantitative and qualitative study of the toxigenic properties of different types. TABLE I.-THE DISTRIBUTION OF SCARLATINAL TYPEs OF STREPTOCOCCI IN 700 CASES OF

Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand

“…ARF is an auto-immune disease triggered in response to infection caused by Group A Streptococcus (GAS) [4,5,6]. This exposure is considered to be largely from pharyngitis, though skin infection may also have a role [7,8,9].…”

The serological types of haemolytic streptococci in epidemic scarlatina

“…An extensive investigation of this nature was reported by Griffith (1927), who found that 60 per cent of strains from acute scarlatina fell into one or other of types 1, 2, 3 and 4 of his classification which now comprises twenty-seven types (Griffith, .1934). Andrewes & Christie (1932) by careful serological analysis were able to identify three of these types, while Allison & Gunn (1932) have confirmed the results in full. No reports have as yet appeared concerning the serological investigation of strains from an epidemic of the magnitude of that experienced in Edinburgh, W t S \ o^ &TA ^TVS&V VV&V) a^ ^TVSSHSB.…”

Carriers and Return Cases in Scarlet Fever

“…showing a complete absence of haemolytic streptococci on discharge is surprisingly small. Gunn and Griffith (1928) in a series of 100 cases found a total carrier rate on discharge of 49 per cent., and Allison and Gunn (1932) in a series of 200 cases reported a rate of 52 per cent. The only difference in the technique of these two investigations and that of the present series is that in our series swabs were taken from each nostril but this would not entirely account for the higher figures now reported.…”

“…Since 1927 a considerable literature has grown round the relationship of the Streptococcus pyogenes to scarlet fever. The work of Griffith (1926Griffith ( , 1927Griffith ( , 1935, Glover and Griffith (1931) and Allison and Gunn (1932), in which the isolation and serological typing of Streptococcus pyogenes were applied to the protean manifestations of infection of the throat by haemolytic streptococci, encouraged the writers to investigate whether the laboratory could throw any further light on the factors governing the occurrence of return cases in scarlet fever. It was also considered of interest to ascertain to what extent the swabbing of convalescent patients would be of help from an administrative point of view, and, at the same time, to enquire whether there were any indications for shortening the period of isolation in scarlet fever.…”

“…of the infecting cases, either alone or in association with other conditions. One-third of the infecting cases had desquamation on leaving hospital; but the opinion of epidemiologists, confirmed by the work of Allison and Gunn (1932) on the rarity of haemolytic streptococci in desquamation scales, is that this condition is most unlikely to be a source of infection. The rarity of rhinorrhoea and the absence of otorrhoea will be noted.…”