Hemolytic streptococci and streptococcal antibodies in normal schoolchildren in Kuwait

A total of 1041 asymptomatic "normal" schoolchildren in Kuwait, aged 6-16 years, were investigated over six months from November 1978 through April 1979 for hemolytic streptococcal throat carriage and for streptococcal immune response. A high carrier rate of beta-hemolytic streptococci (47%) with an unusually high prevalence of group C (32%) was found. Group A was isolated in 10%, group B in 2%, and group G in 3% of the children. Comparison of the prevalence of the different serogroups of beta-hemolytic streptococci in our study with that of similar studies reported from temperate, subtropical, and tropical zones showed a high prevalence of groups C and G and a lower prevalence of group A in subtropical and tropical countries in contrast to a high prevalence of group A and lower prevalence of groups C and G in countries with temperate climate. The geometric mean titer of antistreptolysin O in group A carriers in our study was 270 Todd units and significantly higher than that in group C carriers (p less than 0.001), while the geometric mean titer of antihyaluronidase in group A carriers was 240 units and significantly higher than that in groups B, C, and G carriers (p less than 0.0005). The high magnitude of the streptococcal immune response probably reflects a high frequency of streptococcal infections in schoolchildren in Kuwait and possibly indicates a high attack rate of rheumatic fever in the country.