Brundage J F, Gunzenhauser J D, Longfield J N, Rubertone M V, Ludwig S L, Rubin F A, Kaplan E L
Epidemiology and Disease Surveillance Directorate, U.S. Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving Ground, MD 21010-5422, USA.
Pediatrics. 1996 Jun;97(6 Pt 2):964-70.
To summarize the experiences of the U.S. Army regarding prevention and control, and frequencies, rates, trends, and determinants of febrile acute respiratory diseases (ARDs), particularly Group A beta-hemolytic streptococcus (GABHS).
Since 1966, the U.S. Army has conducted routine surveillance of ARDs among basic trainees. Since 1985, all trainees with fever and respiratory tract symptoms have been cultured for GABHS: Field investigations were conducted when outbreaks of acute respiratory or GABHS-associated illnesses were detected. Mass plus tandem benzathine penicillin prophylaxis were used to interdict and control training center GABHS outbreaks.
During the period 1985 to 1994, there were 65,184 hospitalizations for acute febrile respiratory illnesses among Army trainees. The crude hospitalization rate was 0.45 per 100 trainees per week. The rate consistently declined over the period. Incremental declines were temporally associated with increased use of adenovirus immunizations and broader use of benzathine penicillin prophylaxis. During the period, 10,789 of 59,818 (18%) pharyngeal cultures were positive for GABHS: GABHS outbreaks were associated with diverse clinical manifestations including streptococcal toxic shock, acute rheumatic fever, and pneumonia. The emergence of mucoid colony morphology in clinical isolates was a consistent indicator of circulating virulent strains with epidemic potential. Outbreak-associated M types were M1, M3, M5, and M18. In response to six GABHS outbreaks, mass plus tandem benzathine penicillin chemoprophylaxis produced rapid and sustained GABHS control. ARD and GABHS recovery rates were lowest when benzathine penicillin prophylaxis was widely used.
ARD rates among Army trainees have consistently declined to unprecedented levels. GABHS has reemerged as an important threat to military trainees. Benzathine penicillin chemoprophylaxis is safe and effective for interdicting and preventing GABHS outbreaks in closed, healthy young adult populations.
总结美国陆军在发热性急性呼吸道疾病（ARDs），尤其是A组β溶血性链球菌（GABHS）的预防控制、发病频率、发病率、趋势及决定因素方面的经验。
自1966年以来，美国陆军对基础训练学员中的ARDs进行了常规监测。自1985年起，对所有发热且有呼吸道症状的学员进行GABHS培养：当检测到急性呼吸道疾病或与GABHS相关疾病的暴发时，开展现场调查。采用大剂量加串联苄星青霉素预防措施来阻断和控制训练中心的GABHS暴发。
在1985年至1994年期间，陆军学员中有65184例因急性发热性呼吸道疾病住院。粗住院率为每100名学员每周0.45例。在此期间该发病率持续下降。发病率的逐步下降在时间上与腺病毒疫苗接种的增加以及苄星青霉素预防措施的更广泛使用相关。在此期间，59818份咽拭子培养中有10789份（18%）GABHS呈阳性：GABHS暴发与多种临床表现相关，包括链球菌中毒性休克、急性风湿热和肺炎。临床分离株中黏液样菌落形态的出现是具有流行潜力的循环致病菌株的一致指标。与暴发相关的M型为M1、M3、M5和M18。针对6次GABHS暴发，大剂量加串联苄星青霉素化学预防措施实现了对GABHS的快速且持续的控制。当苄星青霉素预防措施被广泛使用时，ARD和GABHS的恢复率最低。
陆军学员中的ARD发病率持续下降至前所未有的水平。GABHS再次成为对军事学员的重要威胁。苄星青霉素化学预防措施对于在封闭、健康的年轻成年人群中阻断和预防GABHS暴发是安全有效的。
