Measles immunization status in 1972 among first- and second-grade school children in Danbury, Connecticut.

An increased incidence of rubeola among first-grade Danbury school children in 1973 led to a study of seroimmunity to rubeola in a random sample of 60% of the first- and second-grade school children (299) from whom blood samples had been obtained in October 1972 during a voluntary meningococcal vaccination program. Immunization histories derived from physicians' statements on school entry were obtained from school health department records and included date of immunization. Seventy-five percent of the study group had received measles vaccine. Of those immunized prior to 11 months of age only half had an hemagglutinating inhibiting titer (HAI) of greater than or equal to 5 five to seven years later. This antibody level correlates with immunity. Eighty-five to ninety percent of those immunized during or after the 11th month had an antibody titer of greater than or equal to 5. Seventy-one percent of those never immunized also had an HAI titer of greater than or equal to 5 indicating natural infection had occurred. As a result of this investigation, a community-wide program was initiated to vaccinate those who were more than 1 year old as well as reimmunize those who had been vaccinated before the 11th month in accord with current U.S. Public Health Service recommendations for measles immunization.

Community-wide outbreak of group G streptococcal pharyngitis.

Although several outbreaks of group G beta-hemolytic streptococcal (GGBHS) pharyngitis have been described, doubt still remains regarding the etiologic role of GGBHS in acute pharyngitis beyond a limited number of situations. In the winter/spring of 1986/87, throat cultures were obtained from 222 consecutive children seen at a private pediatric office with acute pharyngitis and group A beta-hemolytic streptococci (GABHS) were recovered from 91 children (41%) and GGBHS from 56 children (25%). One patient had both GABHS and GGBHS isolated. This isolation rate of GGBHS was dramatically greater than in previous and subsequent years, and 67% of the GGBHS isolates occurred during an 8-week period. Results of DNA fingerprinting of the 57 isolates of GGBHS demonstrated that 43 (75%) appeared to be the same strain. The patients with GGBHS were comparable to those with GABHS with respect to clinical findings, antistreptolysin-O titer response, and clinical response to antibiotic therapy. However, patients with GGBHS were significantly older (P less than .05). This is the first well-documented, community-wide outbreak of GGBHS pharyngitis and the first respiratory outbreak of GGBHS pharyngitis in a pediatric population. GGBHS may be a more important cause of acute, treatable pharyngitis than had been previously recognized.

Streptozyme test for antibodies to group A streptococcal antigens.

The ability of the Streptozyme test to identify significant antibody rises in 46 patients with streptococcal pharyngitis was comparable to, but no greater than, that of the antistreptolysin O or antideoxyribonuclease B test and inferior to that of the combined use of both the antistreptolysin O and antideoxyribonuclease B tests. Serum specimens were also simultaneously analyzed with three different lots of Streptozyme reagent. Lot-to-lot variation in the reagent resulted in a significant difference in antibody titer for 18 (19%) of the 92 sera tested. Differences among the three lots also produced variation in determining whether a significant rise in titer had occurred from the acute phase to the convalescent phase serum for a given patient. These observations raise concerns about the standardization of the Streptozyme reagent and document the need for precise identification and quantitation of the streptococcal antigens used in this product.

Role of Chlamydia trachomatis and Mycoplasma pneumoniae in acute pharyngitis in children.

In a group of children with acute, nonstreptococcal pharyngitis, only one (2%) of the 44 children tested showed serologic or direct-immunofluorescence evidence of a recent Chlamydia trachomatis infection. Only two (5%) of the 43 children tested showed serologic evidence of a recent Mycoplasma pneumoniae infection. Neither C. trachomatis nor M. pneumoniae appears to be an important cause of acute pharyngitis in children.

Clinical comparison of once-daily cefadroxil and thrice-daily cefaclor in the treatment of streptococcal pharyngitis.

The efficacy of cefadroxil once daily and cefaclor given 3 times daily was compared in 250 pediatric patients with group A beta-hemolytic streptococcal pharyngitis. The duration of the therapy was 10 days. Therapeutic response was based on clinical responses at 24 h and 10 days and throat cultures on days 14, and 21 or 28. Five (5%) cefadroxil-treated patients and 12 (12%) cefaclor-treated patients were still culture-positive on day 14. When the patients were stratified according to major differences between treatment groups observed at baseline, a significant difference between the treatment groups in favor of cefadroxil was found on day 14 (p = 0.020) and days 21-28 (p = 0.043). These data were confirmed by the clinical findings; failure or clinical recurrence occurred in 4.6% of cefadroxil-treated patients versus 22.1% of cefaclor-treated patients. The patients complied with the recommended drug regimen, and none experienced any significant drug-related adverse reactions. The results of this study indicate that cefadroxil given once daily for streptococcal pharyngitis is an effective and well-tolerated antimicrobial agent, and suggest that the desirable pharmacokinetic properties of cefadroxil contribute to this efficacy.

The first urinary tract infection in the female infant. Prevalence, recurrence, and prognosis: a 10-year study in private practice.

Eight hundred healthy female infants presenting for routine care were systematically screened for bacteriuria from early infancy to 2 years of age. The initial urinary tract infection was established in 29 infants, 3.6% of the series, at a median age of 9 months. Continued systematic screening of 25 of these 29 infants with bacteriuria to 6 years of age revealed recurrent infection in nine of them and the development of pyelonephritis in three. Recurrent episodes of infection occurred at close intervals of 2 weeks to 4 months in these nine infants and were clustered within an 18-month period. There were no recurrences after 3 years of age. Characteristically, both the initial and recurrent infections were asymptomatic. Lower urinary tract signs of infection, however, were evident to the "instructed parent," i.e., one instructed in the use of the urinary diary, a written log of the parents' observations of the infant's voiding habits. Pyelonephritis developed early in the children with recurrent infections; it was clinically inapparent and developed in infants with (initially) normal urinary tracts.

Liposome immunoassay for rapid identification of group A streptococci directly from throat swabs.

The Q Test Strep (Becton Dickinson and Co., Franklin Lakes, N.J.) is a new solid-phase liposome immunoassay for the rapid diagnosis of group A beta-hemolytic streptococcal pharyngitis. Compared with blood agar plate cultures, the Q Test Strep had a sensitivity of 91%, a specificity of 83%, a positive predictive value of 88%, and a negative predictive value of 87%. Liposome technology can be used to facilitate the rapid diagnosis of group A beta-hemolytic streptococcal pharyngitis.

Evaluation of a new latex agglutination test for detection of streptolysin O antibodies.

Acute- and convalescent-phase serum specimens were collected from 50 patients with group A streptococcal pharyngitis. The anti-streptolysin O (ASO) titer for each serum specimen was determined by using both the standard neutralization assay and the latex agglutination (LA) test (Rheumagen ASO; Biokit Inc., New Britain, Conn.). When the ASO titers derived by the two methods were compared, the correlation coefficient was 0.93. When the ability of the LA test to demonstrate a significant ASO titer rise (greater than or equal to 2 dilutions) was compared with that of the standard neutralization assay, the LA test had a sensitivity of 91%, a specificity of 86%, a positive predictive value of 83%, and a negative predictive value of 92%. Triplicate LA test determinations were performed on a subset of 31 serum specimens, and for 29 (94%), the repeated ASO titers were all within 1 dilution of each other; the width of the 95% confidence interval for the triplicate measurements of each serum specimen was +/- 32.8 IU. We found the Rheumagen ASO to be a simple, rapid LA procedure for measuring ASO titers that produces results that are highly reproducible, show little lot-to-lot variability, and are comparable to the ASO titers obtained with the standard neutralization assay.

The group A streptococcal carrier state. A reexamination.

Streptococcal infection usually is defined as a positive throat culture with a serologic response to group A beta-hemolytic streptococci, and a patient with a positive throat culture and no serologic response is a streptococcal carrier. Studies suggest that streptococcal carriers should show little clinical response to antibiotic therapy when compared with patients with true streptococcal infections. Patients with acute pharyngitis were divided into three groups: group 1--38 patients with negative throat cultures; group 2--72 patients with a positive throat culture and a significant rise in streptococcal antibody titers; and group 3--77 patients with positive throat cultures and no significant rise in streptococcal antibody titers. Patients in group 2 and group 3 had a comparable and dramatic clinical response to antibiotic therapy that was considerably greater than the clinical response in the patients in group 1. These findings raise questions about the appropriateness of using streptococcal antibody responses to distinguish between the streptococcal carrier state and a true streptococcal infection.