During the period of 1978-1979, a total of 2020 strains of group A hemolytic streptococci isolated in Japan was subjected for the antibiotic susceptibility test and serotyping.
The results obtained are as follows:
1) None of the resistant strain against β-lactam group antibiotics was found as well as the consequence of the former survey.
2) The resistant rate of isolates from scarlet fever patients against TC, CP and MLs were 70.5%, 25.2% and 27% in 1978, and 80%, 47.3%, and 35% in 1979, respectively.
3) The main serotype of the isolates was type 12 in both 1978 and 1979.
And 44.5% of the strains from scarlet fever patient in 1978 and 53.8% in 1979 were found to be the multiple drug resistant.

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Under the cooperation of domestic six institutions, the outline of the transition of type-distribution patterns of group A streptococci during the two years from April 1978 to March 1980was obtained. The percent frequency of type 12, after arriving the highest peak (79.4%) since 1964 when we started agglutination typing using our “T-factor sera” for the first time in the world, droped to 30.5% in 1977, then started to increase again.
The annual transition of percent frequency of drug resistance went in parallel with that of type 12;the overall percent frequency of drug resistance against each of the drugs, after reaching their peaks, i. e., 90.0%, 66.5%, and 52.2% each against tetracycline (TC), chloramphenicol (CP), and macrolides (MLs) respectively, in 1974, declined rapidly toward 1977.This reflected the fact that the most predominated type 12 strains also occupied the highest percentage in multiple drug resistant strains which comprised resistance to TC, CP, and MLs.

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The relationship of type specific M antigen content, streptolysin O titer, serological M type and proteinase production among 173 strains of group A streptococci isolated from scarlet fever patients were studied. As a medium, Todd-Hewitt broth (Difco) was used for culture.
The results obtained were as follows:
1) Out of 173 strains, 92 strains (53.2%) were enzyme negative or trace of enzyme production.
2) In accordance with increasing of enzyme activity, the M antigen content and streptolysin O titer were decreased. Average streptolysin O titer of enzyme-negative strains was 111.5 HD₅₀/ml.
3) As compare with other serotypes, many strains of type 12 produced the enzyme in various extent. Out of 105 strains of type 12, 66 strains (62.9%) were enzyme-positive.

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The present study was undertaken to obtain quantitative data on the recent prevalence of streptococcal infectious disease accompanied with rash, rheumatic fever and acute nephritis in Akira Prefecture, and to classify epidemiologically 21 serotypes of group A streptococci into some classes. The obtained results were summerized as follows.
1. It was estimated to be approximately 25, 143, 495 and 1, 192 patients (per one year) with streptococcal infectious disease accompanied with rash, rheumatic fever and acute nephritis, respectively, based on the data of infectious diseases surveillance and control programs in Akita Prefecture during a 2 year period between 1978 to 1979. While morbidity rates of scarlet fever in this prefecture, 1976 to 1979, revealed 22.7 to 28.3 per 100, 000 of population.
2. From 800 patients with various streptococcal infections, 216 strains and 11 serotypes of group A streptococci were isolated during the period 1976 through 1979. Of these serotypes, 28.7% was type T 4 and 28.2% type T 12.
3. Of 469 persons in 4 regions of this prefecture, 272 (58%) possessed type specific T antibodies against more than one serotype of group A streptococci. The rate of one or more T antibody positive was considerably low in the group of infants under age 3 years, but increased abruptly with age and came to 85.7% at the group of age 10-12 years. The further detailed test revealed that predominant serotypes of detected antibodies against the organisms were T 12, 4, 44, and 14 among 20 detected different serotypes, representing 35.6%, 25.6%, 23.2% and 21.5% in positive rate, respectively. It appeared to be regional differences in the rates of antibody positive and the serotypes of antibodies. It was also suggested that the rates of T antibody positive correlated inversely with the morbidity rates of scarlet fever in the 4 regions.
4. Based on the epidemiological study with positive rates of individual type specific T antibodies and with detection rates of individual serotypes of the isolates from patients with various streptococcal infections, 21 serotypes of group A streptococci were classified into seven classes (type T 2, 8, 9, 25 and Imp. 19; type T 11, 14, 27, 44 and 49; type T 3 and 23; type T 5, 13 and 28; type T 1 and B 3264; type T 6 and 22; type T 4 and 12). On the basis of serotype distribution (ratio) of the detected T antibodies and the isolated streptococci, it was also tried to estimate individual pathogenic indexes of 21 tested serotypes of the streptococci and to classify these serotypes by the indexes into three classes (type T 6, 4, 12, 22 and B 3264; type T 1, 3, 13, 23 and 28; other types)

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A number of papers are available on detection and measurement of streptococcal antibodies to typespecific Mproteins or group-specific polysaccharides, however, a few investigations have been made in regard to T antibodies.
On the other hand, T agglutination typing is employed more frequent than M typing in most laboratories. Therefore, it seemed to be more significant to establish the technique of determination of serum antibodies to streptococcal T proteins. This paper is concerned with the basic studies on determination of antibodies against T proteins of group A streptococci using hemagglutination reaction.
The results were summarized as follows:
1. It succeeded in detection of T4 antibody, but failed in Ti, T6, T8, T12, T22, T28 antibodies.
2. T4 protein was absorbed to group 0 erythrocytes most successfuly under the conditions of employing 1: 2000 tannic acid-treated erythrocytes, 1 mg/ml concentration of T4 protein and pH 6.2 PBS.
3. It was demonstrated that T4 antibody titer obtained was type-specific and was reliable in reproducibility.
4. By using of U-type microplate (NUNC, Denmark), vary small amounts of serum or sensitized erythrocytes and little efforts in reading hemagglutination reaction were needed.
5. The sensitivity oof hemagglutination reaction was 128 times higher than that of bacterial agglutinationreaction.

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In previous studies we demonstrated the hemagglutination reaction for determination of type-specific antibody to T4 protein of group A streptococci. In this report the hemagglutination reaction was applied to clinical and epidemiological studies on T4 antibody in patients with scarlet fever, rheumatic fever, acute glomerulonephritis or other diseases, and in streptococcal carriers.
The knowledge obtained were as follows:
1. No significant differences were found out statistically on T4 antibody titers between patients with scarlet fever and normal controls.
2. In this statistic studies the average of T4 antibody titers and the percentage of T4 antibody possession seemed to be age related; the older children advanced, the higher the titer and the percentage become.
3. It was demonstrated that high levels of T4 antibody were found out in cord sera to a degree equal to the mother's.
4. T4 antibody titers of patients with scarlet fever caused by type T4 strains were much lower significantly (p<0.05) than that of patients caused by other types of strains.
5. T4 antibody titer was elevated much later than ASO or ASK.
6. Streptococcal carriers of type T4 strains were possessed of high levels of T4 antibody.
7. In patients with scarlet fever (by T4 strains) treated with penicillins for seven days, elevated T4 antibody titers appeared later in cases of recurrent positive cultures, however, did not in the cases of negative cultures after therapy.
8. High levels of T4 antibody were recognized in patients with acute glomerulonephritis and rheumatic fever. One of them was showed significant elevation of this antibody during follow up study, and in this case it seemed to be valuable on diagnosis of pathogenic type of strains.

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For the past three years from 1977 to 1979 we have surveyed the incidence of group A-, B-, C- and G-hemolytic streptococci residing in throat of children with asthma, tuberculosis and obesity.
The monthly detection rate of these organisms in tuberculous children were lower than those in asthmatic or obese children.
The detection rate of the streptococci, regardless of the group, among asthmatic and obese children was similar to that among healthy children in U. and K. schools.
The rate of detection of group A-hemolytic steptococci was lower among the ill children groups than among healthy children, but relatively high in 1978 among the obese children.
The two most frequent isolates of group A-hemolytic streptococci were T-22 and T-28.
Detection of T-12, which prevailed 15 to 10 years ago, was low except for children in U. School in 1980.
The rate of detection of group B-hemolytic streptococci was higher than that appeared in former reports throughout the three ill children groups, due probably to the use of our NO blood agar plate (provisional name) in addition to the conventional Columbia CNA sheep blood agar palte.
The most frequent isolates were BIa and B III.
Group C-hemolytic streptcocci were detected frequently in 1977 but far less frequently in and after 1978.
Group G-hemolytic streptococci were in general the second frequent isolates after group B.

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We have conducted a monthly follow-up survey of children with asthma, tuberculosis and obesity for group and type of β-hemolytic streptococci residing in their throat in 1978 and 1979.
The results were as follows:
1. Asthmatic children harbored group A-, B-, C- and G-hemolytic streptococci
more frequently than tuberculous children.
2. Tuberculous children were rarely the carriers.
3. Obese children were similar to asthmatic children in the rate of detection of the group A-hemolytic streptococci, but had sporadical carriers of group A-hemolytic streptococci.
4. Some children were found to harbor two or three groups and/or types of organism on each checkup.

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Commonly available antibiotics were examined for activity against group A-, B-, C- and G-hemolytic streptococci isolated from the throat of children with asthma, tuberculosis and obesity in years of 1978 and 1979.
The antibiotics tested were five penicillins, four cephalosporin antibiotics, three macrolides, tetracycline, chloramphenicol, streptmycin, kanamycin and rifampicin.
The results were as follows:
1. Penicillins were found to be the most active except against group B-hemolytic streptococci, which were more resistant to penicillins than any other test organism in terms of MIC.
2. Cephalosporin antibiotics were active in decreasing order of CER, CET, CEZ and CEX. Of the four different hemolytic streptococcal strains, group B was more resistant than any other congener, and was suppressed only by higher MICs of these antibiotics.
3. Macrolides varied greatly in activity against the four streptococcal groups, and were ineffective against some strains of hemolytic streptococci except the B-group.
4. Tetracycline also varied greatly in activity, and were ieffective against some strains of the four streptococcal groups.
5. Chloramphenicol was similar to tetracycline in activity.
6. Streptomycin was ineffective against most isolates.
7. Kanamycin was ineffective against all the isolates
8. Rifampicin was highly active. We have detected Type III group B-hemolytic streptococcal strains. To our knowledge no strain of hemolytic streptococci has been found to be resistant to rifampicin.
9. Two strains of type 12 group A-hemolytic streptococci were found to be resistant to all the possible conbinations of five antibiotics of TC, CP, EM, OL and JM.
Resistance to rifampicin was always associated with that to TC.
Group C-hemolytic streptococci known to be resistant to TC, if any, were suppressed by any other single antibiotics, but group G-hemolytic streptococci also resistant to TC were refractory to various combinations of the antibiotics tested.

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The surveys for throat-carriers of hemolytic streptococci among children of elementary schools and kindergartens in Tokyo were undertaken in November, 1979 and in February, 1980.
1) Included in the surveys were 552 children of 7 elementary schools and 2 kindergartens in 7 wards and 1 city of Tokyo. In autumn and winter surveys, 546 and 527 children were examined (521 being inspected at both times), and 256 strains of hemolytic streptococci were isolated from 135 (24.7%) and 121 (23.0%) children, respectively.
2) The streptococci wereserogrouped to be 233 group A (91.0%) 15 group G, 6 group B, and 2 group C strains. Serotypes of the group A strains were, in the order of frequencies, T-types 1 (19.7%), 13 (17.7%), 6 (13.3%), 12 (11.6%) and so on. The rates of types 1 and 13 strains were significantly higher in Adachi-ku ward.
3) Among 521 children examined, 53 gave positive cultures at both surveys. Serogroups or serotypes of in the autumn and winter surveys isolates were identical in 27 cases (50.9%).
4) Considerable differences in carrier rates (6.1-38.4%) were seen among institutions.
5) The carrier rates in the autumn and in the winter surveys of 1979 fiscal yearwere not so much different from the corresponding rates obtained in 1977 and 1978 fiscal years.

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