Non-Pharmaceutical Interventions and Military Hygiene at the United States Military Academy between 1890 and 1910.

INTRODUCTION: Military installations are at increased risk for the transmission of infectious disease. Personnel who live and train on military installations live and train near one another facilitating disease transmission. An understanding of historical sanitation and hygiene can inform modern practices. This is especially pertinent considering the continuing rise of variants of infectious diseases, such as the recent pandemic of the 2019 severe acute respiratory syndrome coronavirus 2. In this article, we review the rise and decline of infectious disease at the United States Military Academy (USMA) during the period spanning 1890 through 1910, and the public health interventions used to combat disease spread. MATERIALS AND METHODS: Primary data regarding cadet illness were acquired from the historical archives of the USMA. These included annual reports, clinical admission records, casualty ledgers, and sanitation reports. Unpublished documents from the medical history of USMA provide periodic trends of health among cadets because of infectious disease. RESULTS: Between 1890 and 1910, the USMA at West Point was confronted with cases of influenza, measles, mumps, scarlet fever, smallpox, typhus, and malaria. In response, a series of non-pharmaceutical interventions (NPIs) were instituted to curb the spread of infectious disease. These interventions most likely proved effective in suppressing the transmission of communicable diseases. The most common and arguably the most effective NPI was the physical separation of the sick from the well. CONCLUSIONS: The USMA experience mirrored what was occurring in the larger U.S. Army in the early 20th century and may serve as a model for the application of NPIs in response to modern infectious diseases resulting from novel or unknown etiologies.

Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011-2016.

The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011-2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014.

Scarlet fever notifications surged across the United Kingdom in spring 2014. Molecular epidemiologic investigation of Streptococcus pyogenes infections in North-West London highlighted increased emm4 and emm3 infections coincident with the upsurge. Unlike outbreaks in other countries, antimicrobial resistance was uncommon, highlighting an urgent need to better understand the drivers of scarlet fever activity.

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939-1945.

This paper examines the geographical impact of the British Government's wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939-1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline ('raised') disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939-1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales.

Snippets from the past: is Flint, Michigan, the birthplace of the case-control study?

In the summer of 1924, an outbreak of scarlet fever occurred in Flint, Michigan. Unable to trace it to the usual causes, particularly fresh milk, the Michigan Department of Health used a novel approach to disentangle the enigma: The 116 cases of scarlet fever were compared with 117 "controls" selected from neighbors of the quarantined cases and from patients at the City Health Center who had been treated for ailments unrelated to scarlet fever. The extraordinary culprit was ice cream, which had a frequent/occasional/none consumption prevalence of 60%, 34%, and 6% among the cases and 24%, 51%, and 25% among the controls, respectively. The 1925 report reads, "Detailed epidemiological investigation, by means of case histories and control histories on well persons, confirmed early suspicions and established the fact that the epidemic was spread by ice cream" (Am J Hyg. 1925;5(5):669-681). This forgotten epidemiologic study is the oldest study using the case-control design to have been resurrected thus far. The case-control study design may have been conceived simultaneously, but independently and for different purposes, in England (Janet Lane-Claypon's 1926 report on the determinants of breast cancer) and the United States.

Characteristics of group A Streptococcus strains circulating during scarlet fever epidemic, Beijing, China, 2011.

Scarlet fever is one of a variety of diseases caused by group A Streptococcus (GAS). During 2011, a scarlet fever epidemic characterized by peak monthly incidence rates 2.9-6.7 times higher than those in 2006-2010 occurred in Beijing, China. During the epidemic, hospital-based enhanced surveillance for scarlet fever and pharyngitis was conducted to determine characteristics of circulating GAS strains. The surveillance identified 3,359 clinical cases of scarlet fever or pharyngitis. GAS was isolated from 647 of the patients; 76.4% of the strains were type emm12, and 17.1% were emm1. Almost all isolates harbored superantigens speC and ssa. All isolates were susceptible to penicillin, and resistance rates were 96.1% to erythromycin, 93.7% to tetracycline, and 79.4% to clindamycin. Because emm12 type GAS is not the predominant type in other countries, wider surveillance for the possible spread of emm12 type GAS from China to other countries is warranted.

Rash remarks and practical points.

A letter in the BJN 100 years ago highlighted an interesting nursing point with regard to speaking in front of patients without thinking about their feelings.

[Scarlet fever epidemic during year 1929 in Chile]. / La epidemia de escarlatina del año 1929 en Chile.

Scarlet fever is endemic in Chile, with relatively low morbidity and periodic exacerbations every 4 or 5 years, which can become epidemics. From 1921 to 1927, the number of patients hospitalized in the country fluctuated from 15 to 65 per year, until an epidemic involving nearly 3.000 patients started at the end of 1928 and continued during all 1929. 978 patients died, 537 (52.5%) were from Santiago. Public Health authorities confronted this emergency with prevention, prophylaxis, isolation and treatment measures and 558 beds were disposed for patient hospitalization. Vaccination trials were undertaken and specific treatment with antitoxins was used in patients with toxic clinical cases, having satisfactory results. Convalescent patients were controlled in order to stop the spread of the infection. After approximately 3 years, this disease returned to its regular endemicity.

[Epidemiological situation of infectious diseases in Lvov and Cracow during and after World War I (until the year 1922)]. / Sytuacja epidemiologiczna chorób zakaznych we Lwowie i Krakowie w okresie I wojny swiatowej i po jej zakonczeniu (do 1922 r.).

In Lvov and Cracow at the times of World War I, the infectious diseases such as tuberculosis followed by typhus fever, typhoid fever, dysentery, as well as scarlet fever, diphtheria, measles, whooping cough, smallpox, cholera and venereal diseases (particularly syphilis) posed one of the most significant and dangerous problems for inhabitants. Their increased prevalence was the result of deteriorating sanitary and living conditions of the city population. The spread of epidemic infectious diseases was enhanced by marching troops, migration of civilians and war prisoners, return of large groups of displaced people and demobilized soldiers after regaining independence in November 1918. Additionally, unfavorable epidemiological situation in Lvov deteriorated at the time of the war with Ukrainians (November 1918-April 1919) and Bolsheviks (July-August 1920). The control of infectious diseases was in the hands of regional local physicians who referred patients to hospitals, isolated homes, bath and disinfection institutions, and conducted vaccinations against smallpox. A decrease in infectious diseases prevalence and deaths to the prewar levels occurred in 1922.

Louis I. Dublin and the development of the observational study: the Metropolitan Life Insurance Company natural history (cohort) studies of typhoid fever and scarlet fever.

During 1911-1914, using the resources of the Metropolitan Life Insurance Company, Louis I. Dublin conducted two national studies into the survival of those surviving episodes of typhoid fever or scarlet fever. He identified an elevated risk of such mortality, associated with specific causes of death, among those having had typhoid fever but not among the scarlet fever survivors. The studies were methodologically sophisticated, resembling those conducted three to four decades later. The studies appear to have been accepted by the medical and public health communities. However, the absence of modern data processing technology and the lack of financial support for such studies by other investigators precluded the further development of modern epidemiology until World War II.

La epidemia de escarlatina del año 1929 en Chile / Scarlet fever epidemic during year 1929 in Chile

Scarlet fever is endemic in Chile, with relatively low morbidity and periodic exacerbations every 4 or 5 years, which can become epidemics. From 1921 to 1927, the number of patients hospitalized in the country fluctuated from 15 to 65 per year, until an epidemic involving nearly 3.000 patients started at the end of 1928 and continued during all 1929. 978 patients died, 537 (52.5 percent) were from Santiago. Public Health authorities confronted this emergency with prevention, prophylaxis, isolation and treatment measures and 558 beds were disposed for patient hospitalization. Vaccination trials were undertaken and specific treatment with antitoxins was used in patients with toxic clinical cases, having satisfactory results. Convalescent patients were controlled in order to stop the spread of the infection. After approximately 3 years, this disease returned to its regular endemicity.

La escarlatina es una enfermedad endémica en Chile, de carácter leve a moderado, con morbilidad relativamente baja y exacerbaciones periódicas, cada 4 ó 5 años, de intensidad variable, llegando a constituir, a veces, verdaderos brotes epidémicos. Durante el decenio 1921-1931, el número de enfermos hospitalizados en los distintos establecimientos del país, hasta 1927, osciló entre 15 y 65 por año. A fines de 1928 y durante todo el año 1929, se produjo una epidemia, con casi 3.000 enfermos, falleciendo 978, de los cuales 537 correspondieron a la provincia de Santiago (52,5 por ciento). Las autoridades de Salud Pública (Sanidad, Beneficencia y Asistencia Social), enfrentaron la emergencia con medidas de prevención, profilaxis, aislamiento y tratamiento, habilitándose en la capital 558 camas para la hospitalización de los enfermos. Se emprendieron experiencias de vacunación y además de tratamiento para las formas clínicas tóxicas e hipertóxicas con suero antiescarlatinoso específico antitóxico, con resultados satisfactorios. También se realizó control de portadores convalecientes, con el fin de impedir la difusión del contagio. La enfermedad volvió a su endemia habitual al cabo de más o menos tres años.

[History of the control of acute infectious diseases in Poland after the World War I--until the year 1924 (including big cities)]. / Z dziejów walki z ostrymi chorobami zakaznymi w Polsce po I wojnie swiatowej--do 1924 r. (z uwzglednieniem wielkich miast).

Acute infectious diseases of high intensity, i.e. typhus fever, typhoid fever, dysentery, followed by scarlet fever, measles, malaria, relapsing fever, whooping cough, diphtheria, smallpox and Asiatic cholera spreading after the World War I in Poland posed one of the most significant problems in the reviving country. Their incidence resulted not only from bad living conditions of the population but also from poor personal and environmental hygiene and lack of access to bacteriologically healthy drinking water. The Polish-Bolshevik war (1919-1920) as well as repatriation of war prisoners and the Polish population from Russia (its territory was a reservoir of numerous infectious diseases) and the return of large groups of displaced people contributed to spread of epidemics. Morbidity rate of acute infectious diseases was the highest in the big Polish cities, especially in Warsaw, Lodz, Lvov, Cracow and Vilnius. The Bureau of Chief Emergency Commissar for fighting against epidemics, which closely cooperated with other Polish sanitary institutions and international organisations, rendered the greatest service to the control of infectious diseases. Until the year 1924, the largest foci of diseases were controlled and their incidence decreased, what was possible after formation of sanitary posts along the eastern border of Poland, organisation of infectious disease hospitals, bath and disinfection centres in the country, and implementation of protective vaccinations.

Young patients in a young nation: scarlet fever in early nineteenth century rural New England.

Children in the United States have benefited considerably from advancements in medical and nursing science over the course of the past 200 years. The twentieth century saw dramatic declines in the incidence of childhood diseases; the prevalence of measles, haemophilus influenzae type B, diphtheria, rubella and tetanus are at all time lows (CDC, 2006). Indeed, many pediatric nurses have never seen any of these diseases, something that would certainly have startled their predecessors just a few generations ago. Before the mid- twentieth century, caring for children with communicable diseases represented the cornerstone of pediatric nursing practice. Now that the incidence has decreased among American children, it is easy to forget about these diseases that once decimated whole communities. This article tries to peel back the mists of history by studying children's health in one rural New England town during the days of the early republic in the 1830s.