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Volume-38_Issue-1_April-2025
22
MANIFESTATIONS OF THE EPIDEMIC
PROCESS IN SCARLET FEVER
Fakhriddinova Shakhnoza Fakhriddinovna
E-mail: faxriddinova.shaxnoza@bsmi.uz
Bukhara State Medical Institute
The disease is widespread but is more common in regions with temperate and
cold climates. One of the characteristic features of scarlet fever is the periodic rise
and fall in incidence rates. In addition to 2–4-year intervals, there are also larger time
gaps (40–50 years) followed by a significant increase in the number of cases.
In the early 1660s, T. Sydenham described scarlet fever as "an extremely
insignificant ailment, barely worth mentioning." The clinical picture of scarlet fever
at that time resembled that of the second half of the 20th century. However, just 15
years later, Sydenham encountered a severe form of scarlet fever and classified it
alongside the plague in terms of severity. The 17th and 19th centuries were marked
by alternating periods of mild and severe scarlet fever. Among well-known
observations on this matter, F.F. Erisman noted: "There are periods of exclusively
benign or only malignant epidemics of scarlet fever. The mortality rate in malignant
epidemics is 13–18%, but it often rises to 25% and can reach even 30–40%."
Due to an imperfect registration system and underdeveloped, often inaccessible
medical care for the population, the official statistics of Tsarist Russia did not reflect
the true level of scarlet fever incidence. However, data from the 20th century is
extensive. Over a 100-year period, three large cycles of incidence were identified. By
the end of the century, incidence rates had declined. The vast majority of patients
were children; in Moscow, an average of 7,039 cases were recorded annually from
1996 to 2007, or 461.7 per 100,000 people. No significant trend changes were found
across Russia, where an average of 224.9 children per 100,000 were affected annually.
Between 1996 and 2007, a total of 716,193 cases of scarlet fever were recorded in
Russia, with 64,743 cases in 2007 alone (86,004 cases in Moscow, including 6,590 in
that year).
In recent years, the decline in scarlet fever incidence in Moscow has been more
pronounced than in Russia as a whole: the average annual growth rate (AGR) was –
8% in Moscow and –3% across the country. The sharp decline in scarlet fever cases
observed in the last third of the 20th century has been less pronounced over the past
20 years. Despite the persistent cyclicality characteristic of this form of Group A
Streptococcus (GAS) infection, there has been some stabilization in the spread of
scarlet fever. Over many years, the average incidence rates were 81.0 per 100,000 in
Moscow and 41.1 per 100,000 in Russia. Among children aged 0–14 years in
Moscow, the AGR was –6%, with an annual average incidence of 461.7 per 100,000
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(compared to 0% and 224.9 per 100,000 in Russia). The vast majority of cases
occurred in children—on average, 7,039 cases annually, or 461.7 per 100,000
population. No significant trend changes were found in Russia, where an average of
224.9 per 100,000 children were affected each year.
The overall level and dynamics of long-term and monthly scarlet fever incidence
are primarily determined by the incidence among preschool-aged children attending
organized groups. Each year, children attending daycare and other institutions
contract scarlet fever 3–4 times more often than those raised at home. This difference
is most pronounced in children under two years old (6–15 times higher), while among
children aged 3–6 years, the discrepancy is less noticeable. These age groups also
show the highest rates of asymptomatic bacterial carriage.
Children aged 3–6 years have had the highest average incidence rates of scarlet
fever over many years, with 1,108.7 cases per 100,000 population. Among children
in organized groups of this age, the incidence rate was even higher, reaching 1,290
cases per 100,000 population. High incidence rates were also recorded among
organized children aged 1–2 years (817.6 per 100,000 population). In contrast,
unorganized children aged 3–6 years had an incidence rate of 552.1, and unorganized
children aged 1–2 years had an incidence rate of 167.9 per 100,000 population, which
is 3.4 times lower than in preschool institutions (PSIs). Among schoolchildren, the
incidence rate was 1.8 times lower than in preschool children and 2.8 times lower than
in children aged 3–6 years.
In recent years, scarlet fever has been characterized by a low outbreak intensity.
Among PSIs identified as infection hotspots, 85.6% of them reported only a single
case of the disease. The primary contributors to scarlet fever incidence in organized
children's groups in Moscow are children attending daycare centers (81.6%) and
schools (18.4%).
Scarlet fever incidence can be classified as either year-round (sporadic) or
epidemic. Epidemic outbreaks are marked by seasonal increases or isolated outbreaks.
Seasonal incidence accounts for 50–80% of all registered cases within a year.
The monthly incidence of respiratory streptococcal infections follows a distinct
autumn-winter-spring seasonality. The months with the lowest incidence are July and
August, while the highest rates occur in November–December and March–April.
Seasonal incidence is mainly determined by preschool children attending childcare
facilities. Their incidence rates show two clear peaks: a spring peak (February–April)
and an autumn-winter peak (November–December). Children aged 3–6 years
attending organized groups exhibit a pronounced seasonal pattern, with increased
incidence recorded from early September until the end of July. On average, 78.6% of
cases occur during the seasonal incidence period, with this figure reaching 93% in
some years. In contrast, the seasonal pattern is much less pronounced among
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unorganized children under the age of 2, with only 8.4% of annual cases occurring
during seasonal peaks.
Epidemiological Surveillance
Since scarlet fever is a "disease of organized groups," it is essential to monitor
the incidence of angina and other manifestations of respiratory streptococcal
infections daily in such groups. This helps to detect early signs of worsening
epidemiological situations and predict cases of scarlet fever and rheumatism.
Monitoring the strain structure and biological properties of the pathogen is crucial.
The Group A Streptococcus population is highly heterogeneous and variable in terms
of strain structure and its ability to cause rheumatism, glomerulonephritis, and severe
toxic-septic forms of infection (such as necrotizing fasciitis, myositis, and toxic shock
syndrome). Increases in incidence rates are usually associated with a shift in the
predominant serovar (determined by M-protein structure). Immunological studies
help assess the spread and infection rates of the pathogen in organized groups of
children and adults.
REFERENCES:
1. Анохин В.А. Стрептококковая инфекция у детей и подростков //
Практическая медицина. Общество с ограниченной ответственностью
«Практика». — 2008. — №31. — С.8—14.
2. Афанасьева H.A. Инфекционно—воспалительные заболевания полости
рта и глотки // Российский медицинский журнал = Russian medical journal :
Двухмес. науч.—практ. журн. — М. : Медицина, 2007. — № 5. — С.21— 25.
3. Афанасьева H.H. Псевдотуберкулез у детей // Медицина в Кузбасе :
науч.—практ. журн. / Кемеровская гос. Мед. академия. — Кемерово : НП «ИД
Медицина и Просвещение», Кузбас, 2008. — № 1. — С.З—5.
4. Балабанова P.M., Гришаева Т.П. Инфекция горла — современный взгляд
на методы диагностики и принципы терапии A-стрептококковой инфекции
глотки // Consilium medicum. — 2004. — Т.6. — № 10. — С. 23—25.
5. Белобородов В.Б. Оптимизация применения защищенных пенициллинов
для лечения инфекций дыхательных путей // Российский медицинский журнал
= Russian medical journal: Двухмес. науч.-практ. журн. — М. : Медицина, 2007.
—№ 18. —С. 12—13.
6. Беляков В.Д., Брико Н.И. // Здоровье населения и среда обитания:
Информационный бюллетень / Федеральный цент государственного
санитарно— эпидемиологического надзора. М. : ВНиСО. Ежемес., 1994 — №
10 (19) — С.4—7.
7. Белякова И.В. OF-типирование при изучении эпидемического процесса
стрептококковой инфекции // Журнал микробиологии эпидемиологии и
иммунологии / Минздрав РФ. — М. : Медицина, 1993. — № 2. — С.48— 49.
World scientific research journal
https://scientific-jl.com/wsrj
Volume-38_Issue-1_April-2025
25
8. 1. Келдиёрова З.Д. Состояние иммунной системы у детей с
инфекционным мононуклеозом и обоснование иммунокорригируюшей
терапии.// Central Asian Journal Of Medical and Natural Sciences.
http://cajmns.centralasianstudies.org/index.php/CAJMNS/article/view/422/3972.
9. Келдиёрова З.Д. Иммунологические особенности инфекционного
мононуклеоза эпштейна-барр-вирусной этиологии у детей.// Новый день в
медицине. Бухоро - №2 (34). 2021. https://newdaymedicine.com. Б. 231-234
10. Ряпис Л.А., Брико Н.И., Ещина А.С. и др. Стрептококки: общая
характеристика и методы лабораторной диагно- стики/ Под ред. Н.И. Брико. –
М.: Медицинское информа- ционное агентство, 2009. – С. 195.
