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$Title{Is Rheumatic Fever Common Today?}
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Copyright (c) 1991-92,1993   Tribune Media Services, Inc.


Is Rheumatic Fever Common Today?


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QUESTION:  Is rheumatic fever as common today as when I was a child in the
'20's?

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ANSWER:  By the 1970's, rheumatic fever was so rare in the United States, that
few physicians actually saw a case of it.  In the past three years, however,
there has been a resurgence of the disease in various parts of the country, a
puzzling occurrence that is not yet understood.  Various theories are being
explored to explain its recent return, but at the moment, none have been
proven.
     Group A streptococcal infection in the upper respiratory tract is a major
symptom of the disease, and by the late 1940's, medical researchers discovered
that the fever could be prevented by treating patients who had the
streptococcal infection with penicillin.  As a result of this discovery,
programs offering free throat culturing became popular nationwide.  The link
between the infection and the fever was widely publicized and antibiotic
treatment was stressed.
     The near disappearance of rheumatic fever coincides with the time these
programs were introduced, suggesting that the programs and the availability of
antibiotic therapy aided in the decline.  This conclusion can be further
supported by the fact that in the early '80's the programs were suspended for
cost considerations since the fever had become almost nonexistent.
     Though this data offers a partial explanation for the resurgence of the
disease, it does not give us a totally effective answer to the problem since
antibiotics alone have not removed the threat of the potentially fatal fever.
Rheumatic fever has remained a continual threat in developing countries where
medical treatment isn't as advanced as it is in our country, yet the outbreaks
we are currently witnessing involve middle-class children who have access to
excellent medical care.  Furthermore, only a small percent of these patients
show any evidence of respiratory infection.  This leads experts to believe
that the new outbreaks are being caused by a particularly potent strain of
streptococcus that was not commonly encountered in the past.  Another
explanation can be the tolerance of group A streptococci to penicillin or the
possibility of penicillin destruction by microorganisms in normal flora of the
upper respiratory tract.
     Whatever the reasons, however, identifying and treating streptococci is
still the clinical goal since the risk of developing the fever is reduced to
practically zero when the infection is cured.  An injection of IM benzathine
penicillin every three to four weeks is the most effective therapy, though a
10-day oral dose of penicillin or erythromycin is very effective as well.  In
the long run, the most effective means for preventing future outbreaks will be
the development of a successful vaccine.  Researchers are currently making
promising advances in this area, and in the near future, rheumatic fever will
hopefully be a disease of the past once again.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.