Infect Chemother.  2018 Mar;50(1):38-42. 10.3947/ic.2018.50.1.38.

Investigation of Scarlet Fever Outbreak in a Kindergarten

• Ryu S
• Chun BC

• KMID: 2407966
• DOI: http://doi.org/10.3947/ic.2018.50.1.38

Abstract

BACKGROUND
Scarlet fever is caused by a group A streptococcal (GAS) infection. On April 3, 2017, an outbreak among children in a kindergarten was reported to the local health department. An epidemiologic investigation was conducted to identify the possible transmission route of this outbreak and to recommend appropriate control measures.
MATERIALS AND METHODS
A retrospective cohort study was conducted using questionnaires including age, sex, the classroom attended at a kindergarten, and date and type of symptoms developed. A case-patient is defined as a child having sore throat, fever, skin rash, or strawberry tongue with or without laboratory confirmation of GAS infection between March 28 and April 28, 2017.
RESULTS
The index case-patients developed symptoms on March 28, 2017, and this outbreak persisted over a period of 16 days. The outbreak affected 21 out of 158 children (13.3%) in the kindergarten, with the mean age of 4.2 (range 3-5) years; 12 (57.1%) of them were boys. The common symptoms reported were fever (71.4%), sore throat (71.4%), reddened tonsil (57.1%), and skin rash (52.4%). The epidemiologic analysis showed that children attending one of the classrooms in the kindergarten were 14.12 times affected than the other classrooms (relative risk, 14.12; 95% confidence interval, 4.99-33.93; P < 0.01). All case-patients were recommended to stay away from the kindergarten and its social activities for > 24 hours after starting appropriate antibiotic treatment, and all the children in the kindergarten were instructed to keep strict personal hygiene practices.
CONCLUSION
Our results suggest that the outbreak likely affected from the index case-patients who attended to one of the classrooms in the kindergarten. This highlights the importance of immediate notification of outbreak to prevent large number of patients.

Keyword

Scarlet fever; Outbreak; Children; Kindergarten; Korea

MeSH Terms

Child
Cohort Studies
Exanthema
Fever
Fragaria
Humans
Hygiene
Korea
Palatine Tonsil
Pharyngitis
Retrospective Studies
Scarlet Fever*
Tongue

Figure

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  Figure 1 Floor plan of the kindergarten with the name of classroom

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  Figure 2 Epidemic curve by the date of symptom onset with the name of classroom

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