As the first step to examine the incidences of streptococcal infectious diseases for the nationwide and the regional surveillance information of infectious diseases in Japan, the number of patients with streptococcal infectious diseases per year or week and the hospitals in the surveillance systems in 47 prefectures from 1982 to 1987 were compared. It was found to have the tendency that the numbers of the patients were comparatively more in Hokkaido, Tohoku, partial areas of Kyushu and Shikoku than in other regions, and more in rural areas than in urban areas. Because of the deviation from the tendency, however, it was also suggested that the information of the disease in some prefectures might be poor.
Although ratios of no. of the patients against no. of patients with exanthema subitum in 16 prefectures, respectively, were calculated and compared, it was be not enough to analyze the difference among the incidences of streptococcal infectious diseases in these prefectures.

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Antigen analysis of group A streptococcus strain, “Matsuyama 2166”, which had been typed as T12-28 (by the T-agglutination method), MNT (nontypeable by the M-precipitation method) using conventional typing sera was examined by the precipitation and precipitation absorption technique. The prevalence of group A streptococci, typed under the name “Matsuyama 2166” was also investigated.
The results were as follows:
1) The strain “Matsuyama 2166” is OF (Opacity Factor) (+) and its serological components consist of M “Matsuyama 2166” antigen, which is unique in our collection of M-types, and T28 antigen as a major antigen along with T12 as a minor.
2) Out of the group A streptococci typed as MNT, 96.6% of the streptococci were types as T12-28 and 96.5% of T28 by conventioal typing sera were strains to be typed as M “Matsuyama 2166” using the newly prepared M “Matsuyama 2166” typing serum, suggesting the great advantage to M-typing rate of T28 strains.
3) Group A streptococcus M “Matsuyama 2166” was also found in isolates from Thailand or Malaysia. It is interesting that T-types found in those isolates seems to be a little different from the T-types isolated in Japan.
These results showed that there was the difficult problem when we did the speculation of M-type from the result of T-type.

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The relationship of ASO, ASK and ASP to carrier state of beta-hemolytic streptococcus in throats of healthy schoolchildren was examined from September, 1980 to May, 1987.
The responses to ASO significantly increased in children who detected group A, C and G streptococcus, and ASK in group A and G, and ASP in group A. The responses were especially high in children who detected group A, C and G streptococcus one after the other through the term of research, and in children detected another T type of streptococcus one after the other.
Relatively high titers of ASO and ASK were obtained in sera of children from whom some groups or T types of streptococci were isolated several detection times. ASP titers were not concerned with these times. The elevation of antibodies in paired samples were found as follows; 7 cases in ASO, ASK and ASP together, 42 cases in ASO and ASK together, 3 cases in ASK and ASP together, 2 cases in ASO and ASP together, 41 cases ASO only, 38 cases in ASK only, 7 cases in ASP only. Among these cases with elevation of antibodies titers, several kinds of the change of streptococcal carrier state were observed between obtaining serum of twice. Especially 15 cases with change of carrier state from group A to group A were noticed. Aming these 15 cases, 11 cases isolated another T type strain through the term of reseach, or found to contain the research-time when no streptococcal strain was detected.
Both long term carrier state of the same group or the same type of streptococcal strain and change of carrier state of streptococcal group or T type lead the elevation of ASO and ASK titers.

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The pattern of group distribution of hemolytic streptococci and the source of specimen, when these organisms were isolated from the clinical specimen of the aged, were quite different from that of streptococcosis among children. The isolation frequency from the upper respiratory tract was rather low in comparison to the other specima, such as sputum, exudate and urine. Both groups B and G were predominant among isolatesfrom sputum, B more prevailing than G from exudate, and the isolates from the urinary tract were consisted almost solely of group B. These trends have been unchanged in the past 3 years.
Normal pharyngeal streptococcus flora among the aged also differ from that of healthy children, the carrier rate being rather low, and groups B and G, instead of A in the case of children, being predominant. This pattern of group distribution, among the isolates of normal pharyngeal streptococci of the aged, seemed to be reflected on that of isolates from clinical specima, especially those from the sputum.
The type distribution of group B isolates from normal throat swabs of the aged resemble that of clinical isolates from the same generation, types Ia and III dominating in both cases.

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In oder to analyze the trends of hemolitic streptococcal infections, we have investigated the source of clinical specimens, monthly isolation rates, and the isolation rates by sex and age of patients of 6, 440 hemolytic streptococci (group A, B, C and G) isolated from clinical specimens in hospitals in Saitama during the period of 1979-1987.
1) Serological group of 6, 440 hemoltic streptococci isolated from clinical specimens were 4, 691 (72.9%) isolates of group A, 1, 535 (23.8%) isolates of group B, 47 (0.7%) isolates of group C, and 169 (2.6%) isolates of group G.
2) The main clinical sources of hemolitic streptococci, group A streptococci were 4, 243 (90.7%) isolates from throat swabs, 117 (2.5%) isolates from ear secretions, 87 (1.9%) isolates from nose secretions, and 58 (1.2%) isolates etc., group B streptococci were 647 (42.2%) isolates from urines, 446 (29.1%) isolates from vaginal swabs, 127 (8.3%) isolates from throat swabs, 118 (7.7%) isolates from semens, 55 (3.6%) isolates from urethral secretions, 13 (0.8%) isolates from blood, and 9 (0.6%) isolates from cerebrospinal fluid etc.
3) The monthly isolation rates of hemolitic streptococci, showed that group A streptococci had a general trend by the season, that is, the highest ratio in winter and the lowest ratio in summer, group B streptococci was not influenced by the season.
4) The isolation rates by sex of patients showed that group A streptococci had no difference between male and female, however, group B streptococci showed that the isolation rate of female was higher than that of male with the ratio of 7 to 3.
5) The isolation rates by the age group showed that group A streptococci occupied 85 per cent of the 0-19 year olds, however, group B streptococci occupied 90 per cent in those over 20 years of age.

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During the 21-year period between 1967 and 1987, a total of 6157 strains of group A streptococci isolated in Osaka were type-classified by T-agglutination method. The results were summarized as follows.
1. Sixteen serotypes were differentiated by the T-method during the course of investigation. The most common serotype was T-12 (37.1%), followed by T-4 (13.4%) and T-1 (10.4%).
2. The most dominant serotype was T-12 during 1968-1978, and other relatively frequent serotypes were T-4 in 1971, T-1 in 1972 and T-3 in 1974 throughout the period. Though T-12 was the main serotype in the isolates thereafter, other serotypes such as T-4 in 1979 and T-3 in 1985 also became prevalent, and they occupied the highest percentage. But they declined rapidly, and their duration period was relatively short. After 1976, no definite serotype showed the long-term epidemics, while several types (T-3, T-4 and T-12) showed short-term epidemics lasting a few years.
3. Group A streptococci were isolated most frequently from the patients aged 4-8 years, whereas the isolation rates were extremely lower from the 0-to 2-year-old children. Therefore, younger children seemed to have something which made it difficult to be infected with group A streptococci.

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During the 21-year period between 1967 and 1987, a total of 4678 strains of group A hemolytic streptococci isolated in Osaka were examined for drug sensitivity. The results were summarized as follows.
1.All strains were sensitive to the β-lactam group of antibiotics (benzylpenicillin and cephaloridine).Resistant strains (M.I.C.>25 μg/ml) to tetracycline (TC), chloramphenicol (CP) and erythromycin (EM) were isolated in this study period. The incidence of TC-resistant strains in the whole isolates has not much varied through the whloe period, in spite of the variation among several T-type. But those of CP-and EM-resistant strains varied greatly by year.
2.Before 1971, a small number of resistant strain was found in 1969 and 1970. Since 1972, increase of such strains had been seen and the incidence of CP-resistant strainsreached the highest peak (32.5%).It showed a gradual decrease since 1976 and was 1.1% in 1987.
3.None of EM-resistant strains was isolated before 1972. The incidence of EM-resistant strains exhibited a steep rise in percent since 1973 and reached the highest value showing a two-peak-pattern in 1975 (36.1%) and in 1980 (36.0%).After reaching its peak it decreased gradually and was 2.9% in 1987.
4.Remarkable increase of the multiple drug resistant strains began to be observed since 1972 to 1973, and mainly T-12 and T-4 showed EM.TC.CP-and TC. CP-resistance, respectively. The phenomenon of multiple drug-resistance culminated during 1975-1977, followed by gradual decrease thereafter.Although T-12 tended to be sensitive to all antibiotics, T-4 was keptTC-monoresistant.

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Determination of T-serotype for a total 245 strains (157 strains in 1986, 88 strains in 1987) of Streptococcus pyogenes (Group A hemolytic streptococci) isolated from clinical specimens (throat swab) of pediatric patients in Fukuoka Prefecture from 1986 until 1987 were performed. The susceptibilies of 9 antibiotics against 241 strains were studied. The most dominant strain was T-12 (57 strains, 36.3%) and followed by T-4 (32 strains, 20.4%) and T-28 (30 strains, 19.1%) in 1986. The total of these three strains was 75.8% of all strains. In 1987, T-4 (41 strains, 46.6%) was the dominant strain instead of T-12 (14 strains, 15.9%). T-28 was isolated only 4 strains (4.5%) in 1987, although it was isolated in 30 stains (19.1%) in 1986.
In susceptibility-tests, no strains of 1986 and 1987 was resistant to β-lactams. Resistant strains (MIC>25, ug/ml) to erythromycin (EM), tetracycline (TC) and chloramphenicol (CP) were 4 (2.6%), 51 (33.3%) and 1 (0.7%), respectively in 1986. In 1987, resistant strains to EM and CP were not detected, to TC were 52 strains (59.1%), so there was an increase of susceptibility to EM and CP. As for relationship beween T-serotype and antibiotic resistance, only one strain (T-12) showed multiple resistance in 1986, however in 1987, multiple resistant strain was not detected. In 1986 and 1987, 31 of 49 only TC resistant strains (63.3%) and 41 of 52 only TC resistant strains (78.8%) were T-4, respectively.

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The c protein antigen of group B streptococci has been reported to consist of at least two acid extractable antigens, c^α and c^β. We previously reported that strain FZ301 contain the ca and novel protein antigen, named as S antigen by Denka Seiken, and the ca antigen of this strain exhibit a more complicated structure. In this report described the analysis of the diversity of the ca antigen by immunoelectrophoresis and immunodiffusion.
Hot acid extract from strain A909 produced a single precipitin band against the anti-121424c^α serum but the 121424 extract produced double precipitin bands by immunoelectrophoresis. These ca antigens showed anodic migration, but the 121424ca antigens tended to migrate slower than the A909ca antigen. Moreover, the anti-A909c^α serum produced a single precipitin band when tested after electrophoresis of the 121424 extract. When examined by immunodiffusion, the anti-121424ca serum produced two distinct precipitin bands with the 121424 and FZ301 extract, and these were reactions of identity. However, the A909 extract produced only one band which joined one of the two bands produced with the 121424 extract. These results shown that the strain 121424 contain ca and S antigen as well as strain FZ301.
The precipitin band of the c^α antigen in the A909 extract against the anti-A909 serum formed the spur with the reaction of the ca antigen in the 121424 or FZ301 extract on immunodiffusion. Moreover, the ca antibody in the anti-A909 serum failed to removed completely by repeated adsorption with strain 121424. These results suggest that the c^α antigen of strain 121424 and FZ301 have antigenic determinant in partially common with the A909c^α antigen.

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Distribution of the c protein fractions of group B streptococci and relation to heat-labile antigens for agglutination were investigated.
The results were summarized as follows:
1. Analysis of antigenicity of the c protein in group B streptococcal strains isolated revealed that 74% of the type Ia/c strains carried only a antigen, and 76% of the type Ib/c strains contained both α and β antigens. Component of the c protein freactions in most of type Ia/c strains isolated was different from that in reference strains.
2. Of 37 Ia/c^α strains, 45.9% were determined non-typable, 32.4% were Ia/W, 13.5% were Ia/S, and 8.1% were Ia/Q in the agglutination for heat-labile anigens. Of 8 Ia/c^αβ strains, 87.5% were Ia/Q, and 12.5% were Ia/SW. Of 5 Ia/c^β strains, 60% were Ia/Q, and 40% were Ia/QW. Of 19Ib/c^αβ strains, 68.4% were Ib/-, and 31.6% were Ib/S. Of 5 Ib/c^α strains, 60% were Ib/-, and 40% were Ib/S. One Ib/c^β strain was Ib/-.
3. Because trypsin-sensitive portions of the β antigens were lost, preparation of anigens for agglutination by pancreatic digestion could not exactly reflect results of the precipitation method.

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