Coulehan J L, Baacke G, Welty T K, Goldtooth N L
Public Health Rep. 1982 Jan-Feb;97(1):73-7.
A school-based streptococcal surveillance program has been in effect among Navajo Indians for more than 4 years. Throat cultures of symptomatic children are obtained when indicated, and routine throat cultures are performed monthly. Children whose cultures are positive for group A beta-hemolytic streptococci are treated. During 4 academic years, between 48 percent and 56 percent of elementary school children attended the schools that had 4 or more monthly surveys in each year, but only 24 percent (7 of 29) of the acute rheumatic fever (ARF) cases occurred in children at those schools. Six of seven children attending covered schools were not cultured before their ARF episodes. Five cases occurred in children attending previously covered schools, during years in which participation lapse. Three or four ARF cases per year appeared to have been prevented, but the program's costs were five times the estimated costs of the prevented cases, even excluding risks of allergic reactions to penicillin. There is little evidence that most asymptomatic carriers are at risk to develop ARF. The authors recommend that streptococcal surveillance efforts be confined largely to culturing throat swabs of children with pharyngitis.
一项针对纳瓦霍印第安人的校内链球菌监测项目已实施超过4年。有症状的儿童在必要时进行咽拭子培养，每月进行常规咽拭子培养。A组β溶血性链球菌培养结果呈阳性的儿童接受治疗。在4个学年中，48%至56%的小学生就读于每年进行4次或更多月度调查的学校，但急性风湿热（ARF）病例中只有24%（29例中的7例）发生在这些学校的儿童中。7例患ARF的就读于参与监测学校的儿童中，有6例在发病前未进行培养。5例发生在之前参与监测的学校的儿童中，这些年份监测中断。每年似乎有3至4例ARF病例得以预防，但该项目的成本是所预防病例估计成本的5倍，即便不考虑青霉素过敏反应的风险。几乎没有证据表明大多数无症状携带者有患ARF的风险。作者建议链球菌监测工作应主要局限于对咽炎儿童进行咽拭子培养。
