Scarlet Fever Epidemics Research Articles

A historical syndemic? The impact of synergistic epidemics of measles and scarlet fever on life expectancy in Victoria, Australia (1860s-1870s).

To explore whether synergistic epidemics of measles and scarlet fever in 1860s-1870s Victoria, Australia could be characterized as syndemics, we apply the methods of Sawchuk, Tripp, and Samakaroon (Social Science & Medicine 2022, 295, 112956) to quantify the impact of each of the two major co-occurring epidemic events (1867, 1875) in terms of life expectancy (LE) changes. Sawchuk et al. posit the presence of a harvesting effect, indicated by a statistically significant increase in LE in the immediate post-epidemic "fallow period", as a criterion for identification of a historical syndemic. We test an alternate hypothesis that the same methods can identify a short-term scarring effect. Using annual age- and cause-specific death statistics and census population data, we constructed abridged period life tables for baseline period, potential syndemic year, and "fallow" year for each of the two periods (1860s and 1870s). We compared LE at birth using Z-tests. We decomposed age-cause-specific mortality according to Arriaga's method to identify age-and cause-specific contributions to LE change. LE was significantly lower than baseline (1864-1865) in 1867 but not in the "fallow" year (1869). LE in 1875 and the 1878 "fallow" year were both significantly below baseline (1871-1873). Age-cause-specific decomposition showed similar patterns for 1867 and 1875 for measles and scarlet fever combined effects. Evidence of a scarring effect following the 1875 measles/scarlet fever combined peak supports the interpretation of this event as a syndemic. We suggest the short-term scarring effect can be a useful additional criterion for identifying historical syndemics.

Scarlet fever epidemics, deaths, effects on society and precautions taken in the Ottoman Empire and the Early Turkish Republic

BackgroundScarlet fever, one of the infectious diseases, has become an epidemic in some periods and has become an epidemic in history, causing thousands of people to die. In the Ottoman Empire and the early Republic of Turkey, there was not enough literature about the prevalence of the scarlet fever epidemic, the epidemic level, the mortality status and the fight against the disease.MethodsThe effects of scarlet fever on society during the early periods of the Ottoman Empire and the Republic of Turkey, as well as the measures taken to control the disease, have been researched in Ottoman archival documents.ResultsThe number of scarlet fever patients is 1225 in Anatolian settlements; 429 (35.0%) of them were children, 76 (17.7%) of the children died, and 1796 (65.0%) of them were people, 49 (6.2%) of them died. The number of scarlet fever patients is 147 in Balkan settlements; 36 (24.5%) of them were children, 6 (16.7%) of the children died, and 111 (75.5%) of them were people, 48 (43.2%) of them died. The mortality rate from scarlet fever in the Ottoman Empire was 13.0%. In Ottoman documents, the demographic structure of the society is not detailed. It is only mentioned as adults and children. In a document, it is stated that an older woman died of scarlet fever. Most documents determined that scarlet fever was seen among poor people living in villages and cities. Scarlet fever spread, and more deaths occurred in the villages, mainly due to reasons such as unhygienic conditions, separation of people, and lack of medical personnel. In the early Republic of Turkey, 8865 patients were indicated, and 1681 of them (19.0%) died.ConclusionThe main factors causing the emergence of epidemic diseases were wars and the disruption of society’s lifestyle, socioeconomic conditions and wars.Public Interest SummaryEpidemic diseases have had and continue to have significant effects on public health from the past to the present. In our research, it was determined that scarlet fever causes a significant number of deaths in epidemics. It has been determined that some precautions were taken against the epidemic disease, which are still valid today, but they were less adequate than today’s measures. It has been determined that measures can be developed against current and future epidemics in line with the measures taken against the same disease in the past.

The last hunger years? The 1826–1832 mortality crisis in Denmark

ABSTRACT From 1826 and the six years following, Denmark underwent a severe mortality crisis. The conventional understanding is that it was caused by a malaria epidemic, although recent literature has challenged this. This study examines the demographic and clinical features of this mortality crisis to understand it further. The crisis began in Langeland in 1826 and spread throughout most of Zealand and Lolland-Falster in the following years with a dramatic culmination in the autumn of 1831. In addition to a lethal measles and scarlet fever epidemics in the spring of 1829, the affected regions experienced returning lethal epidemics during harvest in this period. The complex of symptoms during these epidemics resembles enteric infections such as typhoid fever, paratyphoid or E. coli, and typhus fever. In the same period, Denmark also underwent a subsistence crisis from several years with crop failures. The mortality crisis, and namely the harvest epidemics, was probably related to this subsistence crisis. A scarcity of fresh food meant that the rural population ate contaminated food products, making them ill. The crisis thereby exemplifies the synergetic relationship between epidemics and subsistence crises that were common before the breakthrough of the demographic transition in the 19th century.

Epidemije šarlaha u vrtićima u Beogradu

Introduction/Aim: Scarlet fever is mostly a childhood disease and in about 90% of cases it occurs in children younger than 10 years. Outbreaks of scarlet fever always occur in children's collectives (kindergartens, schools and institutions for children). The aim of this paper is to analyze the epidemiological characteristics of scarlet fever epidemics in kindergartens in Belgrade during the five-year period (2016-2020). Methods: Data about new cases of scarlet fever were collected for the observed period from the City Institute for Public Health Belgrade. The data sources used are: epidemiological questionnaire, medical documentation and laboratory results. The presence of b-hemolytic streptococcus group A in diseased children was proven by bacteriological analysis of throat and nose swabs. General and specific incidence rates were used in the data analysis. Results: During the observed five-year period, 30 epidemics of scarlet fever were registered, in which a total of 114 children from 23 Belgrade kindergartens became ill. In 2017, there were 12 epidemics with a total of 49 cases, which represents the largest total number of cases in one year. In the period from 2016 to 2020, the highest number of patients among all patients with scarlet fever was among children aged 4 years (33.3%), and the lowest among children aged 2 years (1.7%). There were slightly more sick boys (57.9%) than girls (42.1%). The highest average five-year incidence rates for scarlet fever were recorded at the age 1-4 (383.7 per 100,000) and 5-9 years (262.8 per 100,000), and the lowest were in persons aged 15 and over. About ⅓ of sick children were registered in the municipality of New Belgrade, and about ⅓ of sick children were registered in the period of early spring (March-April). Conclusion: Respect and timely application of anti-epidemic measures contribute to the successful cessation of further spread of infection (disease reporting, isolation, treatment of sick children, as well as stricter hygiene measures and ongoing disinfection).

Measles and Scarlet Fever Epidemic Synergy and Evolving Pathogenic Virulence in Victoria, Australia, 1853–1916

AbstractFour synchronous epidemics of measles and scarlet fever are observed in the historical data collected by colonial authorities in Victoria, Australia from 1853 to 1876, suggesting some sort of synergistic relationship between the two diseases. While epidemics of measles, as recorded by the colonial record keepers, still occurred during the remainder of the study period (until 1916), no further epidemics of scarlet fever occurred after 1876. This is suggestive of a change in Victoria’s disease ecology in the late 1870s. After analysis of the historical data for potential artifactual cases, it does not appear to be the result of confusion in diagnosis and changes in case definitions do not appear to have affected reporting of the causes of death. We conclude that the most likely explanation for the observed pattern is an epidemic synergy that ended after the 1876 epidemic. We hypothesize that this synergistic relationship between measles and scarlet fever in mid-nineteenth-century Victoria ended due to a shift in the dominant group A streptococci (GAS) M-type or the loss of a GAS bacteriophage. Support for this hypothesis comes from observations that other diagnoses associated with group A strep infections also changed their mortality profiles during the 1870s, particularly “Bright’s disease,” a possible descriptor of post-streptococcal glomerulonephritis. We situate the emergence and end of this pattern within the demographic and socioeconomic conditions of the Victorian gold-mining boom in the 1850s to 1870s and postboom changes in fertility, mortality, and housing infrastructure, highlighting the importance of social conditions in disease evolution.

Current epidemiological aspects of streptococcal and poststreptococcal diseases in the Russian Federation

Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.

Historical Journey of Homoeopathy during Epidemic Diseases in the Light of 2019 Novel Coronavirus Pandemic

Homoeopathy is a therapeutic system founded by German physician Dr Samuel Hahnemann in the late 1700’s and has been used for 200 years around the world in acute and chronic disease conditions. Homoeopathy has also flourished during the times of epidemic diseases and the use of homoeopathic remedies as genus epidemicus and homoeoprophylaxis began with Hahnemann. Although the effectiveness of the homoeopathic remedies in epidemics has been scarcely proved by controlled studies, yet there is vast historical evidence which proves that homoeopathic remedies have been successfully used to prevent these conditions. The homoeopathic literature was searched to find out the historical evidences of the use of homoeopathic remedies during epidemics and pandemics. Homoeopathic treatment during epidemics is reviewed in Eight diseases and their results are found for epidemics of Scarlet fever, Typhus, Cholera, Dysentery, Spanish flu, Diphtheria, Measles, Whooping cough. Also the prophylactic effect of homoeopathic medicines is found in Fourteen epidemic diseases namely Scarlet fever, Smallpox, Poliomyelitis, Meningitis, Whooping cough, Dengue, Cholera, Japanese Encephalitis, Leptospirosis, Diphtheria, Influenza, Hepatitis, Malaria, Chikungunya. Many clinical trials have also been conducted during the epidemics of Chikungunya, Influenza like illness, Dengue, Acute Encephalitis Syndrome/Japanese Encephalitis. The current novel Coronavirus disease, COVID-19, has rapidly spread over the globe and has been declared as pandemic by World Health Organization. Till now, no specific treatment or vaccine has emerge to control this pandemic. However, many homoeopaths over different parts of the world have treated a wide range of COVID positive cases with different remedies. This review not only brings forward the success stories of homoeopathy during past epidemics but also presents its utility in the current pandemic.

Epidemiological study of scarlet fever in Shenyang, China

BackgroundSince 2011, there has been an increase in the incidence of scarlet fever across China. The main objective of this study was to depict the spatiotemporal epidemiological characteristics of the incidence of scarlet fever in Shenyang, China, in 2018 so as to provide the scientific basis for effective strategies of scarlet control and prevention.MethodsExcel 2010 was used to demonstrate the temporal distribution at the month level and ArcGIS10.3 was used to demonstrate the spatial distribution at the district/county level. Moran’s autocorrelation coefficient was used to examine the spatial autocorrelation and the Getis-Ord statistic was used to determine the hot-spot areas of scarlet fever.ResultsA total of 2314 scarlet fever cases were reported in Shenyang in 2018 with an annual incidence of 31.24 per 100,000. The incidence among males was higher than that among females(p<0.001). A vast majority of the cases (96.89%) were among children aged 3 to 11 years. The highest incidence was 625.34/100,000 in children aged 5–9 years. In 2018 there were two seasonal peaks of scarlet fever in June (summer-peak) and December (winter-peak). The incidence of scarlet fever in urban areas was significantly higher than that in rural areas(p<0.001). The incidence of scarlet fever was randomly distributed in Shenyang. There are hotspot areas located in seven districts.ConclusionsUrban areas are the hot spots of scarlet fever and joint prevention and control measures between districts should be applied. Children aged 3–11 are the main source of scarlet fever and therefore the introduction of prevention and control into kindergarten and primary schools may be key to the control of scarlet fever epidemics.

Respiratory health in Canada before 1800

Little is known about respiratory health of the first inhabitants of Canada, as their tradition was oral, and it is necessary to observe the arrival of the Europeans to learn more about it. They were generally considered in good health, before being almost completely decimated by the terrible epidemics of cholera, influenza, measles, scarlet fever, smallpox, typhoid fever, and yellow fever brought by the Europeans. The first descriptions of pulmonary diseases affecting the lungs were those associated with scurvy, caused by vitamin C deficiency, among Jacques Cartier's companions during his second trip to Canada in 1535. Among French immigrants in “Nouvelle-France” (Quebec) in the 17th century, respiratory diseases seemed common, although establishing a diagnosis for a specific condition was not easy at that time, with caregivers limited knowledge and lack of tests to assess patients. In his book, Au temps de la petite vérole, Rénald Lessard reports the writings of one of the first doctors of the colony, Jean-François Gaultier, who relates problems of asthma, angina, catarrh, influenza, colds, and empyema observed in these first comers. We find the mentions of pneumonia, also called peripneumonia, “pulmonie,” “stomach cold,” or “chest exhaustion,” in the middle of the 18th century. There are also reports of “pleurésies” (pleurisy), mentioned as early as 1687; numerous cases are reported in 1708 at the Hôtel Dieu de Québec, the first hospital in North America. Sore throats, whooping coughs, “esquinancies” (the equivalent of the word “angine,” meaning sore throat), and “flux de poitrine” were also common. These problems predominately occurred during the winter season. Pulmonary tuberculosis, so named since the middle of the 19th century, was known as “phthisie” or “consomption pulmonaire.” The more severe health problems were, however, not only respiratory but mainly related to deadly epidemics such as “fièvre pourpre” (typhus) and the measles of 1687 as well as the smallpox epidemic of 1702–1703. When the “Nouvelle-France” was surrendered in 1763, physicians from England, Ireland, and Scotland, mostly military surgeons as in the French regime, took over health care, particularly in large cities. The following text describes the early days of respiratory medicine in Canada, particularly in what would become the province of Quebec, and describes the general state of medicine, caregivers, and treatments of that time.

The Relationship between Varicella (Chicken Pox) and Scarlet Fever in Contemporary Hong Kong

Scarlet fever epidemics have reemerged in China, the UK, and Hong Kong. This research tests whether the scarlet fever epidemics in Hong Kong are linked to varicella epidemics. Varicella infection is a known risk for invasive Group A Streptococcal infections, and new historical research also shows that varicella epidemics were associated with scarlet fever epidemics in the early 20th century in the United States. This analysis examines the relationship between these two disease in Hong Kong from 2011 to 2015 and compares varicella rates before and after the reintroduction of scarlet fever. Analysis shows that scarlet fever and varicella have synchronous annual epidemic cycles, and a mathematical model of the relationship between scarlet fever and varicella is estimated. Varicella rates were unchanged by the return of scarlet fever, but annual varicella cycles may have influenced the size and timing of scarlet fever outbreaks.

The association between varicella (chickenpox) and group A streptococcus infections in historical perspective.

Objectives:The aim of the research is to investigate the historical relationship between varicella and Streptococcus pyogenes infections. In the past few decades, varicella has been identified as a risk factor for invasive group A streptococcus infections. The question is whether this relationship also existed between varicella and scarlet fever in the historical era.Methods:The analysis begins with a search of historical medical reports on the relationship between varicella and scarlet fever epidemics in the late 19th and early 20th century, as well as in more recent empirical studies. Correlations and cross-correlations between varicella and scarlet fever are analyzed using weekly public health case reports from 1924 to 1932 for Boston, Chicago, New York City, and Philadelphia. Regression models are used to estimate the relationship between varicella and scarlet fever after controlling for seasonal forcing.Results:Historical records give limited support for a causal relationship between varicella and scarlet fever but indicate that these diseases often occurred close in time to each other. Likewise, statistical analysis shows that varicella and scarlet fever epidemics are closely aligned with each other, and varicella has a strong relationship with scarlet fever. The relationship is stronger than reported in any previous research on the two diseases.Conclusion:The close correspondence of the two diseases likely depends on multiple factors, including seasonal forcing, a causal relationship, and co-infections. The results raise questions about whether this close relationship might have had a synergistic effect or a role in the evolution of S. pyogenes from the virulent, high incidence epidemics of the 19th century to the relatively benign scarlet fever of the 1950s.

Characteristics of Group AStreptococcusStrains Circulating during Scarlet Fever Epidemic, Beijing, China, 2011

Scarlet fever is one of a variety of diseases caused by group A Streptococcus (GAS). During 2011, a scarlet fever epidemic characterized by peak monthly incidence rates 2.9–6.7 times higher than those in 2006–2010 occurred in Beijing, China. During the epidemic, hospital-based enhanced surveillance for scarlet fever and pharyngitis was conducted to determine characteristics of circulating GAS strains. The surveillance identified 3,359 clinical cases of scarlet fever or pharyngitis. GAS was isolated from 647 of the patients; 76.4% of the strains were type emm12, and 17.1% were emm1. Almost all isolates harbored superantigens speC and ssa. All isolates were susceptible to penicillin, and resistance rates were 96.1% to erythromycin, 93.7% to tetracycline, and 79.4% to clindamycin. Because emm12 type GAS is not the predominant type in other countries, wider surveillance for the possible spread of emm12 type GAS from China to other countries is warranted.

Early detection on the onset of scarlet fever epidemics in Beijing, using the Cumulative Sum

Based on data related to scarlet fever which was collected from the Disease Surveillance Information Reporting System in Beijing from 2005 to 2011, to explore the efficiency of Cumulative Sum (CUSUM) in detecting the onset of scarlet fever epidemics. Models as C1-MILD (C1), C2-MEDIUM (C2) and C3-ULTRA (C3) were used. Tools for evaluation as Youden's index and detection time were calculated to optimize the parameters and optimal model. Data on 2011 scarlet fever surveillance was used to verify the efficacy of these models. C1 (k = 0.5, H = 2σ), C2 (k = 0.7, H = 2σ), C3 (k = 1.1, H = 2σ) appeared to be the optimal parameters among these models. Youden's index of C1 was 83.0% and detection time being 0.64 weeks, Youden's index of C2 was 85.4% and detection time being 1.27 weeks, Youden's index of C1 was 85.1% and detection time being 1.36 weeks. Among the three early warning detection models, C1 had the highest efficacy. Three models all triggered the signals within 4 weeks after the onset of scarlet fever epidemics. The early warning detection model of CUSUM could be used to detect the onset of scarlet fever epidemics, with good efficacy.

Scarlet Fever Outbreak, Hong Kong, 2011

Scarlet Fever Outbreak, Hong Kong, 2011

A pestilence stalks abroad': familial clustering of deaths during the Tasmanian scarlet fever, measles and influenza epidemics of 1852-1854

At the time the first colonists arrived in Tasmania in 1803, the island was almost certainly free of Old World epidemic diseases. Eventually, however, all the ‘stock diseases’ were to make their appearance. In 1852–54, Tasmania suffered concurrent epidemics of scarlet fever, measles and influenza. In 1853, 493 of 1,992 total deaths were attributed to one of these diseases; mortality of children aged 1–4 and 10–14 tripled, while mortality of children aged 5–9 years increased five-fold. This paper considers age-sex patterns of cause-specific mortality in Tasmania in 1852–54, and how mortality in these years differed from that of non-epidemic years. The paper also investigates whether deaths were more likely to cluster within families during these epidemic years compared with non-epidemic years. This study is based on family reconstitutions derived from a complete dataset of births, deaths and marriages registered in nineteenth-century Tasmania. Rebecca KIPPEN, Australian Research Council Future Fellow Centre for Health and Society, School of Population Health, University of Melbourne, Australia. E-mail: rkippen@unimelb.edu.au

Mark Twain and Medicine: "Any Mummery Will Cure" (review)

Reviewed by: Mark Twain and Medicine: "Any Mummery Will Cure" Justin Kaplan K. Patrick Ober . Mark Twain and Medicine: "Any Mummery Will Cure."Mark Twain and His Circle Series. Columbia: University of Missouri Press, 2003. xix + 362 pp. Ill. $47.50 (0-8262-1502-5). Mark Twain's survival to the age of seventy-five was a triumph of man over medicine. From boyhood on he was the targeted beneficiary of practically every brand of doctoring and pseudo-doctoring his century had to offer. Practitioners of allopathic medicine subjected boys like Sam Clemens to purging, blistering, bloodletting, and other torments. Much later, and by then famous as Mark Twain, Sam went on to submit to homeopathic medicine, the water cure, "starvation therapy," electrotherapy, osteopathy, and Christian Science "absent treatment" (for a compound fracture, as he joked, that made him look like a hat rack). His mother, also a lifelong seeker for the ultimate nostrum, swore by Perry Davis's Pain Killer, a ferocious compound of alcohol and cayenne pepper that, taken internally, roasted the patient's innards; it was supposed to ward off cholera and alleviate chills, cramps, and colic. Although incurably derisive about patent medicines, Mark Twain, nearing sixty, planned to market an invention of his own, labeled "Clark's Swift Death to Chilblains" and consisting of kerosene mixed with [End Page 902] cheap perfume to disguise the smell. He also made a characteristically disastrous investment in another preparation supposedly endowed with universal virtues: Plasmon (also known as "Vienna Albumen"), an all-purpose nutrient made from powdered skim milk. An internist on the faculty of Wake Forest University School of Medicine, K. Patrick Ober has written a book with a double nature: Mark Twain and Medicine is a colorful, entertaining survey of nineteenth-century quackeries and orthodoxies; it is also an informal medical biography of Mark Twain, a one-man textbook of ailments. Dr. Ober details his subject's bouts with childhood diseases, gout, "tobacco heart," severe angina, and miscellaneous miseries, all part of a "lengthening list of medical disappointments" (p. 146). "Nothing agrees with me," Mark Twain complained at seventy; "If I drink coffee it gives me dyspepsia; if I drink wine it gives me the gout; if I go to church it gives me dysentery" (p. 141). Mark Twain was not a hypochondriac. Aside from his own genuine ailments, he had grown up in a climate of illness, disease, pathology, and violent death. As a boy he once stumbled over the corpse of a murdered man; he apparently witnessed through a keyhole his father's autopsy; and for a week he sat by the bed of his brother Henry, fatally scalded in a steamboat explosion. Like other towns in the Mississippi River Valley, Hannibal, Missouri, where he spent his early years, had a frightful rate of infant mortality and was periodically ravaged by epidemics of scarlet fever, cholera, and malaria. Ober supplies a fascinating account of the local medical celebrity, Dr. Joseph McDowell. Eccentric to the point of insanity, McDowell owned a cave (commemorated in Tom Sawyer) where he kept the cadaver of a young girl in a vat of alcohol. Mark Twain's wife was a severe "neurasthenic," according to the fashionable diagnosis of the time. She survived typhoid fever, suffered from hysterical paralysis (treated by a faith healer), and lingeringly died of chronic congestive heart failure. Of their four children, a son, Langdon, sickly and born prematurely, died at seven months; daughter Susy died of spinal meningitis; daughter Jean suffered from epileptic seizures; and daughter Clara "developed emotional problems after her mother's death and spent the better part of the next year in a sanatorium" (p. 282). Student, victim, and scourge of nineteenth-century therapies and cures, late in life Mark Twain gleefully accepted the honorary degree of doctor from the New York Postgraduate Medicine School. When he began his healing practice, he reported to the faculty, there had been "lots and lots of sick people" in his community; "There aren't any now" (p. 2). Justin Kaplan Cambridge, Massachusetts Copyright © 2004 The Johns Hopkins University Press

Nutrition and Scarlet Fever Mortality during the Epidemics of 1860-90: The Sundsvall Region

This article examines the social and economic contexts in which three scarlet fever epidemics appeared in rural parishes surrounding the Swedish town of Sundsvall during the later nineteenth century. This preliminary investigation challenges studies that have discounted a possible relationship between nutrition and scarlet fever. It suggests that poor nutrition during pregnancy may have caused women to give birth to children who were particularly susceptible to scarlet fever. It is also possible that years of food shortages may have made it difficult for some mothers to nurse their infants and that this increased the likelihood that they would fall victim to the disease when the next epidemic occurred. Food shortages, brought about by a rapidly increasing population, below average harvests, the extraordinary development of the sawmill industry, and severe winters, often hampered the most determined efforts of local inhabitants to find sufficient amounts of nutritional food. Frequently, this compromised the immuno-competence of young children. This study uses patterns in crop yields, annual wages, and various demographic indicators to identify those years in which it would have been most difficult to maintain adequate levels of nutrition. District physicians' reports and computerized parish records provide the mortality data used to identify patterns of scarlet fever mortality.

The dynamics of scarlet fever epidemics in England and Wales in the 19th century.

There was a marked rise in scarlet fever mortality in England and Wales in the mid-nineteenth century and spectral analysis of the registration details, 1847-80, shows that the interepidemic interval was 5-6 years, but after 1880 the endemic level fell and the fatal epidemics disappeared. The dynamics of the scarlet fever epidemics can be represented by a linearized mathematical model and because the system is lightly damped, it could be driven by an oscillation in susceptibility. Epidemics were significantly correlated with dry conditions in spring/summer (P < 0.001), suggesting that these produced a low amplitude oscillation in susceptibility which drove the system. Epidemics also correlated (P < 0.001) with an oscillation in wheat prices but at a lag of 3 years, suggesting that malnutrition during pregnancy caused increased susceptibility in the subsequent children which interacted synergistically with seasonal dry conditions. Scarlet fever mortality was sharply reduced after 1880 in parallel with falling wheat prices suggesting that the remarkable period of high scarlet fever mortality (1840-80) was dependent on poor nutritive levels during that time.

INTRODUCTION

During the second World War, and even almost a decade later at the conclusion of the Korean Conflict during the 1950s, infections caused by the Group A beta hemolytic streptococcus and their nonsuppurative sequelae were major problems for practicing physicians as well as for public health authorities. Epidemics of scarlet fever were ever present; quarantine signs could be seen prominently displayed in the windows of the homes of schoolchildren. Many schoolchildren had at least one schoolmate who was homebound and bedridden for months with rheumatic fever. The perceived threat of Group A streptococcal infections was of concern to the lay public, especially to parents of schoolchildren. For the medical community the presence of rheumatic fever hospitals in many cities, institutions like the Harriet Lane Home in Baltimore, the Irvington House in New York, the House of the Good Samaritan in Boston, and La Rabida Hospital in Chicago, served to reinforce the need for increasing the understanding and control of these infections. If those facts about Group A streptococci and children were not sufficiently impressive, the large numbers of individual cases and even outbreaks occurring in military troops during the second World War and during the Korean Conflict further emphasized the issue. In fact, before the second World War, relatively little was understood about the epidemiology and pathogenesis of these infections and their sequelae. The laboratory studies of Rebecca Lancefield and others, which allowed more precise identification and characterization of Group A streptococci, and the accompanying clinical observations provided the foundation for early control measures.

Temporal variation in bacterial disease frequency: molecular population genetic analysis of scarlet fever epidemics in Ottawa and in eastern Germany.

In an effort to understand the molecular genetic basis of temporal variation in frequency and severity of bacterial disease, genetic relationships among strains of Streptococcus pyogenes that caused scarlet fever epidemics in Canada in the early 1940s and in eastern Germany in the 1960s to 1980s were studied. Application of multilocus enzyme electrophoresis and comparative sequencing of the gene (speA) encoding streptococcal pyrogenic exotoxin A (scarlet fever toxin) revealed that new waves of scarlet fever are associated with an increase in frequency of S. pyogenes clones carrying variant speA alleles. This finding suggests that the occurrence of new scarlet fever epidemics can be predicted by comprehensive monitoring of the frequency of S. pyogenes clones with variant toxin alleles.