[Rheumatic fever and rheumatic heart disease].
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While rheumatic fever is becoming an uncommon disease in all parts of the United States, it still exists in all areas including Southern California. The disease is sufficiently common in Los Angeles County to warrant organized programs of control aimed particularly at careful follow-up, accurate case reporting, secondary prophylaxis and primary prevention.In April of 1965 a Rheumatic Fever Workshop, in which local, national and state experts in rheumatic fever participated, reviewed the status of the rheumatic fever programs in Los Angeles County. Guidelines for future organization for the control of rheumatic fever were developed and presented.
This review of the medical literature reveals that the incidence of rheumatic fever has been declining for at least 150 years, preceding by many decades the use of penicillin as a preventive measure. Simultaneously, the prevalence of rheumatic heart disease has diminished. Streptococcal upper respiratory tract infections remain common but with reduced severity and fewer subsequent cases of rheumatic fever. Scarlet fever has become relatively benign, with low mortality. Whether recent sporadic outbreaks of rheumatic fever due to known rheumatogenic strains of group A streptococci will have a significant effect on morbidity and mortality trends remains to be seen. Relatively high rates of rheumatic fever and rheumatic heart disease in developing countries are difficult to evaluate because of irregularities in reporting and investigative procedures.
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