AN EPIDEMIOLOGICAL INVESTIGATION OF A STREPTOCOCCAL AND RHEUMATIC FEVER EPIDEMIC IN DICKINSON, NORTH DAKOTA

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Abstract
Data have been presented relating 11 cases of acute rheumatic fever to a high prevalence rate of Group A streptococci in a population of school children in Dickinson, North Dakota. The majority of cases of rheumatic fever did not have a clear cut antecedent streptococcal infection which came to the attention of the examining physicians. Carrier rates for beta-hemolytic streptococci approached 50 to 60% on the initial survey, and rapidly diminished over a 6-week period. Approximately 60% of the Group A streptococci were typeable, and one-third of these were Group A, Type 5. Convalescent antistreptolysin O titers obtained on a group of fifth grade school children, of two schools followed, clinically revealed significantly high titers above any described in previous civilian epidemiological studies but comparable to epidemic strains seen in the military. A virulent Group A, Type 5 streptococcus explosively spread through this community and undoubtedly was responsible for a high attack rate of rheumatic fever. Recommendation for civilian mass prophylaxis on the basis of the data obtained from this epidemic may be made for the first time.

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