Eradication of rheumatic fever: an unfulfilled hope

Rheumatic heart disease is considered one of the few forms of chronic heart disease which can be effectively prevented today. Yet the incidence of rheumatic fever is still appreciable and the complacency of many physicians and public health officials in regard to the rheumatic fever problem is unwarranted. It is timely, therefore, to reexamine the question of whether this disease can indeed be eradicated by presently available methods.

One of the major factors limiting the prevention of initial attacks with antibiotics is that about two thirds of the patients who develop rheumaic fever do so following either asymptomatic or mild streptococcal infections. Furthermore, the low socioeconomic group, in whom the risk of rheumatic fever is the greatest, is the least likely to receive adequate care even for overt respiratory infections. Although the number of recurrent attacks has been reduced, approximately 10% of rheumatic patients still develop recurrences either because they are not on prophylaxis at all or they take their medication irregularly.

It is clear, therefore, that the availability of effective preventive agents is not synonymous with effective prevention. While the conditions which account for this fact can be modified so that the incidence of rheumatic fever can be reduced, the disease will not be eradicated until a more biologic means to prevent streptococcal infections becomes available.