An Epidemiological Investigation of Group A β-Hemolytic Streptococcus Infections and a Scarlet Fever Outbreak in a Private Kindergarten in Peitou District of Taipei City
2002 Vol.18 NO.8
An epidemiological investigation of a scarlet fever outbreak and infections of group A β-hemolytic streptococcus at a private kindergarten in Peitou District of Taipei City on 27 November 2000 was conducted. The purpose was to understand the scale of infections of scarlet fever in the kindergarten and its routes of transmission for adequate disease control measures. The investigation took the forms of physician diagnosis, collection of throat swabs from suspects, follow-up of sources of infection, and establishment of surveillance and reporting system, instead of the conventional disease control measures of general screening and prophylactic medication. Control measures were group health education, encouraging individuals with symptoms for medical care, and disinfection of the environment. Of the 566 children, 39 teachers and employees, two scarlet fever cases and eight GABHS carriers (symptoms not meeting definition of scarlet fever) were detected by physician diagnosis and screening for symptoms. The attack rate of scarlet fever for the kindergarten as a whole was 0.3% (2/605). Results of the investigation suggested that the location of the classroom of the cases, crowdedness of classrooms, long-time stay in kindergarten, and close personal contact were major routes of transmission. Follow-up of the sources of infection found that the index case had been infected with scarlet fever three times in six months. As no GABHS serotyping was made, it was not possible to decide whether the infections were by GABHS of the same serotype, or because of drug resistance, or other factors. More investigations are required.