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The Natrona County Primary Prevention Program, Casper, Wyo

Brendan Phibbs, MD; Joanne Taylor, RN; Robert A. Zimmerman, PhD

JAMA. 1970;214(11):2018-2024.

Abstract
A unique, legally enforced, mass-culture program for detection and treatment of streptococcal pharyngitis has been in effect in Natrona County, Wyoming, since 1954. To evaluate the impact of such a program on the streptococcal milieu, the Streptococcal Disease Section, Ecological Investigations Division, Public Health Service, studied a randomized sample of the children under surveillance. The study revealed an extremely low total streptococcal isolation rate (1.8%), as well as antibody levels consistent with a low level of streptococcal infection. The percentage of students with group A antibody was half that of comparable groups in the region; type-specific antibody titers against six streptococcal types revealed values significantly lower than in uncontrolled schoolchild groups in the Rocky Mountain region. The control measures appear to have altered the streptococcal milieu in a favorable manner.

Author Affiliations
From the Rheumatic Fever Control Committee, Natrona County (Wyoming) Medical Society, Casper (Dr. Phibbs); the Northern Wyoming Streptococcal Laboratory, Casper (Nurse Taylor); and the Streptococcal Disease Section, Ecological Investigations Program, National Communicable Disease Center, Fort Collins, Colo (Dr. Zimmerman).

Footnotes
Reprint requests to 230 S Washington St, Casper, Wyo 82601 (Dr. Phibbs).

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