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Severe streptococcal infections in historical perspective.
1Section of Epidemiology, School of Public Health, University of Hawaii, Honolulu 96822.
Summary
Severe streptococcal disease outbreaks echo 19th-century scarlet fever pandemics. Understanding historical streptococcal strain circulation and immunity is key to preventing current severe infections.
Area of Science:
- Microbiology
- Epidemiology
- Immunology
Background:
- Recent unexplained increases in severe streptococcal diseases in the US and Great Britain warrant investigation.
- Historical analysis of the 1825-1885 scarlet fever pandemic offers insights into severe streptococcal disease patterns.
Observation:
- Scarlet fever, though not fully representative, was the primary severe streptococcal illness identified in the 19th century.
- 19th-century scarlet fever exhibited co-circulation of virulent and less-virulent strains, leading to cross-immunity.
- Hyperendemic strains were prevalent in urban centers, with periodic spread to rural and developing regions.
Findings:
- Maternal antibodies transferred via placenta or breast milk offered infants protection against infection, but not fatal disease post-infection.
- The historical data suggest complex epidemiological features of severe streptococcal diseases.
Implications:
- Further research into streptococcal epidemiology is crucial for preventing severe diseases.
- Identifying streptococcal virulence factors and their distribution is essential for public health strategies.
- Characterizing current streptococcal isolates from patients and the general population is a necessary first step.