Investigation of scarlet fever outbreak in a primary school, Surin Province, Thailand, January 4th– March 31st, 2560

Abstract

Background: Scarlet fever is caused by Streptococcus pyogenes. In the past 10 years, Surin had no epidemic of Scarlet Fever. However, the first patient, diagnosed on January 5, 2017 was found in kindergarten school. Surin SRRT teams conducted an investigation to describe epidemiology and risk factors of the outbreak, and to provide prevention and control from 4 January to 31 March 2016.
Methods: A descriptive study was conducted to of determine epidemiological characteristics of Scarlet Fever outbreak, Case definition was diagnosis by doctor and clinical result by throat swab culture by studying the appearance, distribution of disease by person, place and time. And environment survey was done to identify risk of transmission. Throat swabs were collected from symptomatic cases to confirmed cause of the disease.
Results: A total of 759 children were screened. We found 76 infected patients, 40 male (52.6%) and 36 female (47.4%). Median age of patient was 7 years old. Most patient went to private hospital. Sixty nine cases (90.79%) were diagnosed with scarlet fever and 7 cases (9 . 2 1 %) were diagnosed with suspected scarlet fever. Clinical symptoms were illustrated 88. 89% in high fever, 86. 67% in erythematous rash, 68. 89% in sore throat and tonsillitis, 44.44% in white tongue, 26.67% in swollen tongue liked strawberries, 15.56% in nausea and vomiting, 6.67% in swollen tonsillitis, 6.67% headache, and 4.4% in Aphthous ulcer. None of patient pass away. The result of 38-samples bacterial cultures were 31. 58% in β- Hemolytic Streptococcus group A, 60.53% in normal Throat Flora, 7.89: each 2.63% in Staphylococcus aureus, Streptococcus pneumoniae and Beta-hemolytic Streptococci. Environment survey show that the classrooms: library, music room and auditorium, which were used together easily contaminated. Schools should have a health screening system for all students every morning in order to sort out sick children. The responsible for public health should regularly communicates with teachers and parents.
Conclusions: The outbreak was a propagated source. The result of one-month surveillance was no new cases because of a recess period. All patients who have been diagnosed with this disease have to be continuously monitor for the complications for 2 years.