Streptococcal school outbreaks: a method of investigation and control

Abstract

A method of controlling outbreaks of streptococcal infection of the upper respiratory tract in communities such as boarding schools is described.It is suggested that, in a search for carriers, nose and mouth swabs should be taken in place of the customary nose and throat swabs. These swabs will detect those who are dispersing streptococci into the environment, as distinct from the carriers who are not dispersers. It is essential that infections of the skin and ears should also be looked for.It is recommended that all dispersers, whether nose or mouth positive, should receive sulphanilamide insufflation in both nostrils twice daily for a week, or longer if necessary, without exclusion from school. In addition, penicillin lozenges for 2 days may be recommended for the mouth positives only.The history is considered to be an important factor in deciding the extent of the initial investigation, and examples are given to illustrate this. When mass swabbing is considered necessary, it is highly desirable that the whole community should be swabbed at the same time, as early as possible in the outbreak. It is also desirable that bacteriological follow-up should be available to check that control has been effected.