(Streptococcal Pharyngitis)
Jennifer Cardin,
Melinda Clingen, Kathrine Neal, and April Brown
What is it?
One of
the most common bacterial infections in children is "strep throat." Strep
throat is a disease caused by an egg shaped bacteria that causes ten percent
of all sore throats and is found in the throat and on the skin (http://kidshealth.com).
The Group A (GAS) bacteria is the most frequent encountered in mid-winter
and early spring. Not all people get strep throat; some are only carriers
of the bacteria. A study shows that about twenty percent of school
age children are asymptomatic carriers and only eight to thirty percent
of children actually get strep throat (http://health.discovery.com). When
this infection is not treated, it can lead to other serious problems; such
as rheumatic fever, arthritis, toxic shock, and a variety of other ailments.
Strep throat is very contagious and can be passed very easily between
students and teachers.
Symptoms
A person
with a sore throat that is caused by a runny nose, cough, or other symptoms
of the common cold is almost never due to GAS. Some of the signs
and symptoms of GAS are:
- sore throat that starts suddenly
- fiery red throat
- painful swallowing
- white film covering the tonsils
- enlarged neck lymph nodes
- fever of over one hundred degrees
- headache
- loss of appetite
- fatigue
- nausea
- vomiting
- abdominal distress
- red blushing rash, a sign of scarlet fever ( in more severe cases)
How Doctors
Diagnose Strep Throat
In 1954,
the first throat cultures were used to diagnose strep throat in the offices
of pediatricians and general practitioners. Throat cultures are performed
by rubbing the patient's throat with a cotton swab to obtain a sample. However,
the bacteria takes several days to grow and the patient is left to worry
about the outcome.
This practice has become a more common practice and has grown rapidly since the early 1980's. The Center of Disease Control estimated by the early 1980's, anywhere from twenty-eight to thirty-six million cultures had been performed annually in the United States.
In the 1990's, a more rapid detection strep test (rapid kit) came into play at the cost of a ten day supply of penicillin. These tests have the same reliability as the throat culture. The strep molecules are detected within minutes. However, sometimes the negative kit results are followed by a throat culture. (Wald and Fischer, Feb 2004)
This practice has become a more common practice and has grown rapidly since the early 1980's. The Center of Disease Control estimated by the early 1980's, anywhere from twenty-eight to thirty-six million cultures had been performed annually in the United States.
In the 1990's, a more rapid detection strep test (rapid kit) came into play at the cost of a ten day supply of penicillin. These tests have the same reliability as the throat culture. The strep molecules are detected within minutes. However, sometimes the negative kit results are followed by a throat culture. (Wald and Fischer, Feb 2004)
Treatments
The main
treatment for strep throat is penicillin. For a person that is allergic
to penicillin, another antibiotic will be prescribed. Antibiotic therapy
is usually completed in seven days. It is very important to take the
full prescription to prevent any further complications from the strep infection.
A child may return to school if he has no fever and symptoms have improved
for twenty-four hours of starting the antibiotic therapy.
Other ways to help reduce the symptoms are:
http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm
Other ways to help reduce the symptoms are:
- lots of rest
- gargling warm salt water
- throat lozenges
- over-the-counter medications to reduce fever and pain
- plenty of fluids to prevent dehydration
- cool mist humidifier
- dispose of all toothbrushes (the bacteria will live in the bristles)
http://www.nlm.nih.gov/medlineplus/ency/article/003053.htm
PRECEDE-PROCEED
MODEL
Social Diagnosis
Because strep throat is highly contagious among school children, schools
will sometimes have a number of students out at one time. It is difficult
to keep a handle on the infection because not all children complain when
they feel bad, parents send children to school with all the symptoms in
question, and/or the antibiotic therapy has not been completed.
A current growing health issue is the number of teachers now contracting strep throat and other autoimmune diseases. Teachers are being hit harder and more often with these ailments than any other profession due to the environment. (Sore Throat, Jan. 2004)
A current growing health issue is the number of teachers now contracting strep throat and other autoimmune diseases. Teachers are being hit harder and more often with these ailments than any other profession due to the environment. (Sore Throat, Jan. 2004)
Epidemiological
Diagnosis
After checking several web sites, only about 8 to 30% and 5-9% of teenagers
with fever and throat inflammation actually have strep throat. Research
also shows that about 20% of all school age children may be carriers of
the bacteria and will never show symptoms but will transmit the strep to
others. Symptoms in up to about 40% of children are too mild to diagnose.
(http://www.genzymediagnostic.com)
In a study, teachers from the age 35-44 mortality rates were 50% higher than any other profession and high school teachers were 55% higher than elementary teachers from autoimmune diseases such as strep throat. (http://educationworld.com)
In a study, teachers from the age 35-44 mortality rates were 50% higher than any other profession and high school teachers were 55% higher than elementary teachers from autoimmune diseases such as strep throat. (http://educationworld.com)
Behavioral
and Environmental Diagnosis
Health professionals (school nurses and pediatricians) should monitor
outbreaks more closely. Children should be checked when entering
back into the school system for fever from a bout with strep throat. Teachers
should be aware of the signs and systems and inform the school nurse.
Teachers should also be aware of their own health. After being exposed in the classroom, they must remember that they are also susceptible to the bacterial infection and must take necessary steps not to further infect other students and staff members. (Eaton, Mar 2001)
Educational Diagnosis
Teachers should also be aware of their own health. After being exposed in the classroom, they must remember that they are also susceptible to the bacterial infection and must take necessary steps not to further infect other students and staff members. (Eaton, Mar 2001)
Educational Diagnosis
Faculty, parents,
staff, and students are not being educated on strep throat. Those
who have contracted strep throat receive information on the infection when
they go to the doctor's office. Strep throat education needs to be
taught in the schools as well as the doctor's offices so the faculty, parents,
staff, and students are aware of the seriousness of the infection.
Administrative and Policy Diagnosis
Implementations, Processes, Impacts, and Outcomes
Implementation #1: Based on research findings, it is advised that schools, parents, teachers, students, and the community be better informed about strep throat by August 2005.
Administrative and Policy Diagnosis
School
officials have policies stated in the handbooks about returning to school
after an illness or having fever. The problem with these policies
is the fact that they are ignored. For example, one policy reads:
"12. Strep Throat and Scarlet Fever: Students may return to school after twenty-four hours of treatment with antibiotics, provided treatment is continued as prescribed. If a throat culture has been done and the student is not being treated, the student may not return to school until the results have been provided and treatment has been given for at least twenty-four hours if the culture is positive."
In the same policy, it also states that the school district can request a doctor's permit to allow the child back in school. If the administration would enforce these standards, there would not be many outbreaks of strep throat or GAS infections. However, after research, no policy was found about teachers returning to work after having strep throat or any illness. http://www.geneva.k12.il.us
"12. Strep Throat and Scarlet Fever: Students may return to school after twenty-four hours of treatment with antibiotics, provided treatment is continued as prescribed. If a throat culture has been done and the student is not being treated, the student may not return to school until the results have been provided and treatment has been given for at least twenty-four hours if the culture is positive."
In the same policy, it also states that the school district can request a doctor's permit to allow the child back in school. If the administration would enforce these standards, there would not be many outbreaks of strep throat or GAS infections. However, after research, no policy was found about teachers returning to work after having strep throat or any illness. http://www.geneva.k12.il.us
Implementations, Processes, Impacts, and Outcomes
Implementation #1: Based on research findings, it is advised that schools, parents, teachers, students, and the community be better informed about strep throat by August 2005.
- Process: Doctors and clinics giving information about strep throat and other GAS infections to the schools, parents, teachers, students, and the community would evident in the process of implementing this suggestion.
- Impact: The impact on intermediate objectives of this suggestion would be evidenced by the awareness of the schools, parents, teachers, students, and the community to the seriousness of strep throat and other GAS infections.
- Outcome: The outcome on social indicators, disease or death rates of this suggestion would be evidenced by fewer cases of strep throat, GAS infections, and lower mortality rates in school faculty, staff, and students.
Implementation
#2: Based on research findings, it is advised that
by August 2005, schools should have licensed school nurses who can detect
early signs of strep throat and other GAS infections.
- Process: The process of implementing this suggestion would be evidenced by schools hiring licensed school nurses.
- Impact: The impact of implementing this suggestion would be evidenced by early detection of strep throat and other GAS infections.
- Outcome: The outcome on social indicators,
disease or death rates would be evidenced by lower morbidity and mortality
rates due to strep throat or other GAS infections in faculty, staff, and
students.
Implementation #3: Based on research findings,
it is advised that by August 2005, schools will provide training on proper
disinfecting methods for faculty, staff, and students.
- Process: The process of implementing this suggestion would be evident by training seminars and classes on proper disinfecting methods.
- Impact: The impact of implementing this suggestion would be evidenced by fewer cases of strep throat among faculty, staff, and students.
- Outcome: The outcome on social indicators would be evidenced by lower morbidity and mortality rates due to strep throat and other GAS infections.
Implementation
#4: Based on research
findings, it is advised that as soon as it is available, schools require
strep throat vaccination for faculty, staff, and students.
- Process: The process of implementing this suggestion would be evidenced by shot records provided to the school before classes begin.
- Impact: The impact of implementing this suggestion would be evidenced by fewer cases of strep throat among faculty, staff, and students.
- Outcome: The outcome on social indicators would be evidenced
by lower morbidity and mortality rates due to strep throat and other GAS
infections.
Implementation #5:
Based on research findings, it is advised
that by August 2005, schools require all students and teachers recovering
from strep throat to have a doctor's clearance to return to school.
- Process: The process of implementing this suggestion would be evidenced by strict standards of returning to school after illness.
- Impact: The impact of implementing this suggestion would be evidenced by fewer outbreaks of strep throat passed from one to another.
- Outcome: The
outcome on social indicators would be evidenced by lower morbidity and mortality
rates due to strep throat and other GAS infections.
Related Web Sites
Related Journal Articles
- Diagnosing Strep Throat in the Adult Patient: Do Criteria Really Suffice? Annals of Internal Medicine, July 15, 2003; Vol.139 Issue 7, p.150, 2p
- The Strep Throat Connection; Harvard Mental Health Letter, July 2002 Vol 19 Issue 1, p. 5, 1p.
- Rapid Antigen In Office Test 90% Accurate for Strep Throat; Kohn, Carol; Henderson, CW; TB and Outbreaks Week, Dec 2001-Jan 2002, p.14, 2p.
- What Clinical Features are Useful in Diagnosing Strep Throat? Eaton, CA; Journal of Family Practice, Mar 2001, Vol 50 Issue 3, p. 201, 1p
- Diagnosing and Treating Strep Throat; Wald, ER; Fischer, DR; Family Practice Management, Feb 2004, Vol 11 Issue 2
- Strep Throat; Ebell, MH; American Family Physician, Sept 2003, Vol 68 Issue 5,p. 937, 2p, 1 diagram
- Sore Throat; American Family Physician, Nov 2003, Vol 69 Issue 2, p390, 1p
- Strep Vaccine to Be Tested in Humans; Key, Sandra; De Noon, Daniel; Boyles, Salynn; Vaccine Weekly, July 2000, p12, 2P