Control programmes for streptococcal disease among rural school children

Rheumatic fever remains important in New Zealand, and rheumatic heart disease is common. In a high risk area, a study of primary preventive strategies was undertaken among primary school children. The principal aim was to reduce beta-haemolytic streptococcal throat carriage. Subordinate aims were to reduce sickness-related absenteeism and the clinical incidence of streptococcal disease. The strategies compared included (1) identification and treatment of asymptomatic carriers at three-monthly surveys; (2) between-survey home visits of a nurse to identify infections and encourage prompt referral to the family doctor; (3) an exercise programme intended to increase general and respiratory fitness. Some benefit resulted from each strategy but the exercise programme was the least costly. The benefits of treatment of carriers and home visiting are probably insufficient to make them worthwhile.