The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project.

The feasibility and effectiveness of a programme for the community control of rheumatic fever and rheumatic heart disease were studied in a cooperative multicentre project initiated and coordinated by the World Health Organization. The programme was carried out in seven centres in various developing countries of Africa, America, and Asia according to a common protocol, and is under way in a further eight countries in Latin America. Pilot community programmes were shown to be practicable and effective in reducing the burden of rheumatic heart disease in developing countries and their extension to cover entire populations should be encouraged.

The range of antistreptolysin-O titer among 3129 healthy individuals in winter and summer in Tehran, Iran.

A rise in ASO titre can be demonstrated in 75-80% of patients following untreated streptococcal upper respiratory infection. The difficulty, however, is that there is no such thing as normal ASO titre. The levels encountered in a given population depend upon age, geographical location, season, etc. It was, therefore, on this basis that sera were taken from 3129 healthy individuals during winter and summer in Tehran for the determination of ASO titres. Sixty-three individuals were treated both during summer and winter. During summer only 4 (6%) had titres above 250 T.U. and 59 (94%) below 250 T.U. The same individuals, when tested during the winter, showed that 7 (11%) had ASO titres above 250 T.U. and 56 (89%) below 250 T.U. This seasonal difference is statistically significant. In another study 320 individuals were tested during summer and another 394 individuals during winter. Among the summer group 31 (10%) were above 250 T.U. and 289 (90%) were below 250 T.U. In the winter group 55 (14%) were above 250 T.U. and 339 (86%) were below 250 T.U. This difference is again statistically significant. Further, 35 samples of pooled sera representing 2289 individuals were treated during the winter. Here 563 (24%) were above and 1723 (76%) were below 250 T.U. The possible sources of error in this group, in comparison with the other, are discussed.

Microbiological and epidemiological study of streptococcal sore throat at a children's clinic: a one-year study.

From October 1973 to September 1974, throat cultures were taken from 578 patients who referred to the Children's Clinic with upper respiratory tract infection. One hundred fifty-one (26%) of the sick children yielded beta-hemolytic streptococci and 427 (74%) of the pharyngitis cases were considered as viral. The most susceptible ages for streptococcal and viral pharyngitis were 5-8 and 2-6 years respectively. The peak seasonal incidence for streptococcal sore throat was from late autumn to early spring. There was a positive correlation between the incidence of upper respiratory infection and streptococcal isolation. From 100 strains of beta-hemolytic streptococci isolated and tested, 86 were group "A", 4 group "C", 2 group "G" and 8 non-groupable. From 86 group "A" strains. 71 (82%) were typable by agglutination ("T"-typing), but only 49 (57%) by precipitation ("M"-typing). The most prevalent "M" types were types 1 and 12. There was 95% correlation between serological and bacitracin disk method for grouping of hemolytic streptococci. All strains isolated were sensitive to penicillin, erythromycin and chloramphenicol, but 11 strains were resistant to tetracyclin.

Rheumatic fever and rheumatic heart disease among 56,8000 inhabitants in southeast Teheran from 1972-1974.

A study of the incidence of R. fever in an area in southeast Teheran during the period 1972-1974 revealed 92 cases. The crude annual incidence of R. fever ranged from a high of 58 cases to a low of 51 cases per 100,000 population. The age and sex specific rates revealed the incidence to be strikingly higher in the 5-19 year age group, reaching roughly 80/100,000. There was an approximately similar number of males and females with R. fever. Among the R. fever patients, there were 6 cases of chorea, 5 girls and 1 boy. From 92 R. fever cases, 49 (53%) developed carditis. Among these patients, 35 (71%) were female in contrast to 14 (29%) male cases. Overall there were 59 cases (62%) which were initial attacks and 33 cases (38%) which were recurrences. During the trial there were also 7 recurrences of R fever and 4 deaths. The seasonal pattern showed that the majority of cases occurred during the winter and spring months. From the R. fever/R.H.D. patients, 63 (70%) and from cases with carditis alone, 24 (40%) were hospitalized.

Comparative trial of tetracycline, chloramphenicol, and trimethoprim-sulphamethoxazole in eradication of Vibrio cholerae El Tor.

A comparison of tetracycline, chloramphenicol, and trimethoprim/sulphamethoxazole showed that all hasten the eradication of Vibrio cholerae from the stools of patients with cholera.A four-day period of tetracycline or trimethoprim/ sulphamethoxazole was adequate for eradicating V. cholerae from the stools of all patients, but three days, as suggested by the W.H.O. Expert Committee, was not. Four days of chloramphenicol therapy was sufficient for most patients, but a minority required up to seven days' therapy.Purging produced reappearance of V. cholerae in the stools of one-eighth of the patients who had had three successive daily negative stool cultures; such patients are a potential danger to the population.