title: Epidemic streptococcal disease among Army trainees, July 1989 through June 1991.
abstract: Outbreaks of group A streptococcal infection occurred at four of seven US Army basic training installations between 1 July 1989 and 30 June 1991. Study data were collected through a respiratory disease surveillance program and on-site epidemiologic investigations. Although hospitalizations were frequent (range, 191-334) during each outbreak, average rates of hospitalization were low (2.4-4.8 hospitalizations/1000 trainees/week). Outbreak-associated morbidity included streptococcal toxic shock syndrome (2 cases, 1 fatal), acute rheumatic fever (6), acute glomerulonephritis (1), scarlet fever (1), and numerous other invasive sequelae. Four serotypes of Streptococcus pyogenes (M-1, -3, -5, and -18) were identified; M-18 caused significant disease at 2 installations. Disease control was rapidly achieved through prophylaxis programs using benzathine penicillin G in nonallergic trainees. These outbreaks extend other reports that document an evolution of the nature and severity of circulating S. pyogenes in the United States.
authors.affiliation: Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Gunzenhauser
authors.forename: J N
authors.initials: JN
authors.lastname: Longfield
authors.forename: J F
authors.initials: JF
authors.lastname: Brundage
authors.forename: E L
authors.initials: EL
authors.lastname: Kaplan
authors.forename: R N
authors.initials: RN
authors.lastname: Miller
authors.forename: C A
authors.initials: CA
authors.lastname: Brandt
mesh_terms: D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005921:Glomerulonephritis / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008499:Medical Records; D008889:Military Personnel / Q000706:statistics & numerical data*; D009017:Morbidity; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D011159:Population Surveillance; D012213:Rheumatic Fever / Q000209:etiology; D012541:Scarlet Fever / Q000209:etiology; D012703:Serotyping; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D013297:Streptococcus pyogenes / Q000145:classification; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D010401:Penicillin G Benzathine