Thirty-five per cent of the measles patients showed throat cultures positive for B. influenzæ on admission to the hospital. On repeated cultures, this rose to 84 per cent before discharge.
Ward separation of cases of measles carrying hemolytic streptococci in their throats and cases not carrying these organisms were practiced in handling this epidemic. Of 867 cases of measles treated in this manner, 37 were positive for hemolytic streptococci on admission, and 205 developed positive throat cultures for these organisms during their period of observation in the hospital.
At Camp Pike, the percentage incidence of S. hemolyticus “carriers,” on admission to the measles wards, was 4.2 per cent. In cases recultured after one week, it was 10.9 per cent; after two weeks 22.8 per cent; after three weeks 26.2 per cent; and after four weeks 33.1 per cent. The weekly development of “carriers” in the “clean” treatment wards was during the first week 9.1 per cent; during the second week 17.4 per cent; during the third week 17.4 per cent; and during the fourth week 17.4 per cent.
The principal complications of these 867 cases of measles at Camp Pike were: pneumonia, 56 cases; otitis media, 48 cases, with subsequent mastoiditis in 23 cases, 2 of which had extensions to the meninges and brain. The greater part of the pneumonia occurred early in the period of observation, while most of the otitis media occurred later. Incidence of hemolytic streptococci was low during the pneumonia period and high during the prevalence of otitis media.
Hemolytic streptococci complicated 9 of these pneumonias; caused a large percentage of otitis (bacteriology incomplete), and 21 of the 23 cases of mastoiditis.
The bacteriology of 35 of the 56 pneumonias showed: Pneumococcus Type II atypical, in 36 per cent, Type IV in 22.9 per cent, Type I in 2.8 per cent and Type III in 2.8 per cent; hemolytic streptococci in 22.4 per cent; and B. influenzæ in 88.6 per cent.
The culturing of wards as units revealed widespread contact dissemination of hemolytic streptococci, at times 25 to 50 per cent of the patients in a ward becoming “carriers” within the period of a week. Streptococcus pneumonias, otitis media and its complications were furnished in large part by wards in which active dissemination occurred.
Streptococcus complications did not occur among 37 patients who were “carriers” of hemolytic streptococci when admitted to the hospital.
The epidemic dissemination of hemolytic streptococci occurs in measles wards, and is a serious danger. Many, patients whose throats become infected, develop no symptoms. In some instances streptococcus invades, and renders much more serious lesions caused by other microorganisms.
Methods to prevent transfer of infection within the ward and separation of “carriers” from “noncarriers” in different wards are efficient in keeping epidemic dissemination of hemolytic streptococci under control. Frequent throat cultures and prompt report of the results of cultures are essential.