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Epidemic streptococcal disease among Army trainees, July 1989 through June 1991
J D Gunzenhauser1, J N Longfield, J F Brundage
1Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC, USA.
The Journal of Infectious Diseases
|July 1, 1995
Summary
Group A Streptococcus outbreaks in US Army training bases caused severe illness, including toxic shock syndrome. Rapid prophylaxis with penicillin G effectively controlled the spread of these invasive *Streptococcus pyogenes* infections.
Area of Science:
- Epidemiology
- Infectious Diseases
- Microbiology
Background:
- Group A Streptococcus (*Streptococcus pyogenes*) outbreaks can occur in congregate settings.
- Previous outbreaks have been documented, but the evolving nature of *S. pyogenes* strains and their associated diseases requires ongoing surveillance.
Purpose of the Study:
- To investigate outbreaks of group A streptococcal infection at US Army basic training installations.
- To identify the *S. pyogenes* serotypes involved and assess the severity of associated diseases.
- To evaluate the effectiveness of control measures.
Main Methods:
- Respiratory disease surveillance program data collection.
- On-site epidemiologic investigations during outbreaks.
- Identification of *Streptococcus pyogenes* serotypes.
Main Results:
- Outbreaks occurred at 4 of 7 installations between July 1989 and June 1991.
- Hospitalizations were frequent, but average rates were low (2.4-4.8/1000 trainees/week).
- Severe morbidity included streptococcal toxic shock syndrome (1 fatal case), acute rheumatic fever, and acute glomerulonephritis. Serotypes M-1, -3, -5, and -18 were identified, with M-18 causing significant disease.
Conclusions:
- Group A Streptococcus outbreaks in military training settings can lead to severe, invasive disease.
- Benzathine penicillin G prophylaxis was effective in controlling disease spread.
- These findings highlight the evolving nature and severity of circulating *S. pyogenes* strains.