Scarlet fever control on modern lines

Abstract

As the clinical condition known as scarlet fever is merely one of many manifestations of streptococcal infection, its incidence cannot be controlled effectively unless official notification and isolation are applied to all forms of infection by the same causative organism. Although the prevalent type of scarlet fever is a mild disease with a very low direct fatality rate, its complications—and other infections by the same organism—are conditions responsible for serious subsequent morbidity and a high remote fatality. Scarlet fever patients aggregated in multiple-bed wards are exposed to serious risk from secondary infection and complications, especially when the standards of bed-spacing and nursing efficiency are diminished during epidemic periods. Removal to hospital merely for the purpose of isolation is not a necessary measure of control, and there is no evidence of increased risk to patients or contacts when isolation is carried out in the home. The return-case rate after release from hospital isolation is seven times greater than after home isolation. In view of the evidence of the extent of secondary infection in multiple-bed wards, separate cubicles for all patients must be regarded as the ideal form of hospital provision. At present the most practicable method of cubicle isolation is in the home. Routine terminal disinfection does not exercise any appreciable effect in preventing the spread of infection. When scarlet fever patients are isolated at home, routine exclusion of school contacts appears to be unnecessary.