Streptococcal infections among children in a residential home: I. Introduction and definitions: the incidence of infection

Abstract

1. In a children's home with an average population of about 460 children aged from 0 to 15 years, 473 attacks of acute sore throat, 354 attacks of otitis and 314attacks of other acute febrile respiratory tract illness were recorded in the 30 months from November 1950 to April 1953.2. The attack rate for all forms of illness and at all ages was higher among children in a reception group, who were mostly recently arrived in the home, than it was in the permanent residents.3. Of all ifinesses with the principal signs or symptoms referable to the throat, the proportion that yieldedStreptococcus pyogenesrose from about 34 % in the 1–2-year- old children to about 74% in the children aged 10 years or more. Streptococcal sore throats made up about 8% and about 38 % of all febrile respiratory tract illnesses in the same two age groups.4. The attack rate for streptococcal sore throat varied from month to month between 0 and 6 5 % of the children at risk; only one period of substantially increased prevalence was observed and there was no indication of any seasonal trend. Non-streptococcal sore throat varied between FO and 20 % per month. It was not possible to recognize any epidemics of streptococcal otitis; non-strepto coccal otitis had a definite winter prevalence associated with the rise in the total of non-streptococcal respiratory disease.5. There was a slight indication that tonsillectomized children had rather milder attacks of sore throat than non-tonsifiectomized under the routine sulphamezathine treatment adopted. About 86 % of all children stifi harboured the causative streptococcus in their throat on discharge from hospital. The tonsifiectomized children lost their throat, but not their nose, streptococci in convalescence more rapidly that the non-tonsillectomized. Among throat carriers, the tonsifiectomized children carried streptococci in their nose more often than the non-tonsilectomjzed at all stages in their illness and convalescence.6. Bacteriological examination of excised tonsils did not often reveal the presence of streptococci that had been undetected in throat swabs. Twenty-one of twenty- two children who had had a streptococcal respiratory tract ifiness treated with suiphamezathine within the 3 months preceding their tonsifiectomy were found to harbour the same streptococcus in their tonsifiar tissue; only four of eighteen children whose illness had been treated with penicillin still harboured the streptococcus.Streptococcal infections in children. I 61