An outbreak group A streptococcus infection (scarlet fever), Phetchabun Province and Loei Province, Thailand, February–March 2018
Keywords:
scarlet fever, group A streptococcus, food-borne streptococcal pharyngitis infection, APSGNAbstract
Background: On March 5th, 2018, Division of Epidemiology received a notification of 13 patients presenting with fever with rash admitted to a district hospital in Petchabun province. The patients had history of joining a wedding ceremony in a village in Lom Kao district. Joint Investigation Team investigated the outbreak to confirm diagnosis, describe the outbreak, and determine source of infection.
Methods: A descriptive study was conducted. We reviewed medical records and interviewed the patients. A suspected scarlet case was defined as a person living in or attending ceremonies held in the village and had at least 2 symptoms as follows: fever, sore throat and rash. A confirmed scarlet case was the suspected case with evidence of Group A streptococcus infection. Environmental and case-control studies were done to identify factors associated with the infection.
Results: Total of 123 scarlet fever cases (37 confirmed and 86 suspected) were found from 2 adjacent districts in Phetchabun province and Loei province. Median age of cases was 37 years (range 1–78 years). The onsets were between February 13th–March 9th, 2018. Most of cases had high fever (97.56%), sore throat (90.24%), followed by a scarlatina rash (46.34%). Spicy Raw beef salad was associated with the infection (aOR = 2.91, 95%CI 1.22–6.95). Some suspected case were food handlers participating in cooking and serving processes during the ceremonies. Some case only ate the food without attending the ceremonies. At 1 month later, 9.09% of the scarlet cases had abnormal urinalysis and 2 cases (2.27%) were diagnosed acute post-streptococcal glomerulonephritis (APSGN). All of them did not properly take antibiotics.
Conclusion: Although this scarlet fever outbreak was likely food-borne, contact and droplet transmission in the ceremonies could not be ruled out. Food hygiene during a ceremony should be strengthened. Awareness for antibiotics use should be raised in the population.
References
Center for Disease Control and Prevention. Scarlet fever [internet]. [cited 2020 July 16]. Available from: https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html
ชมรมกุมารแพทย์โรคหัวใจแห่งประเทศไทย. แนวทางการ ปฏิบัติมาตรฐานเพื่อการวินิจฉัยและการดูแลรักษาผู้ป่วยโรคไข้ รูมาติกในประเทศไทย [อินเตอร์เน็ต].กรุงเทพฯ: ราชวิทยาลัย กุมารแพทย์แห่งประเทศไทย; 2559 [เข้าถึงเมื่อ 16 ก.ค. 2563]. เข้าถึงได้จาก: http://www.thaiheart.org/images/column_1291454908/ARFGuideline.pdf
Public Health England. Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings October 2017 [internet]. 2017 [cited 2020 July 16]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/771139/Guidelines_for_the_public_health_management_of_scarlet_fever_outbreaks__.pdf
พรอำภา บรรจงมณี, อัจฉรา ตั้งสถาพรพงษ์. Scarlet fever [อินเตอร์เน็ต]. กรุงเทพฯ: สมาคมโรคติดเชื้อในเด็กแห่ง ประเทศไทย. [เข้าถึงเมื่อ 16 ก.ค. 2563]. เข้าถึงได้จาก: https://www.pidst.or.th/A765.html
พจมาน ศิริอารยาภรณ์, ลักขณา ไทยเครือ. การสอบสวนทาง ระบาดวิทยา. ใน: พื้นฐานระบาดวิทยา (Basics of Epidemiology). กรุงเทพมหานคร: สมาคมโรคติดเชื้อในเด็ก แห่งประเทศไทย; 2557. หน้า 181–5.
G. Gallo, R. Berzero, N. Cattai, S. Recchia and G. Orefici. An Outbreak of Group A Food- Borne Streptococcal Pharyngitis Infect. European Journal of Epidemiology [Internet]. 1992 [cited 2020 July 18]; 8:292–7. Available from: https://link.springer.com/article/10.1007%2FBF00144817
G. FALKENHORST, J. BAGDONAIT, M. LISBY, S. B. MADSEN, L. LAMBERTSEN, K. E. P. OLSEN, K. MØLBAK. Outbreak of group A streptococcal throat infection: don’ t forget to ask about food. Epidemiol Infect [Internet]. 2008 [cited 2020 July 18]; 136(9): [1165– 71]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870919/
Center for Disease Control and Prevention. PostStreptococcal Glomerulonephritis [internet]. [cited 2020 August 17]. Available from: https://www.cdc.gov/groupastrep/diseases-hcp/post-streptococcal.html
Center for Disease Control and Prevention. Outbreaks and Public Health Response [internet]. [cited 2020 October 9]. Available from: https://www.cdc.gov/groupastrep/outbreaks.html
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