Historical aspects of rheumatic fever

Abstract

Few diseases have experienced such a remarkable change in their epidemiology over the past century, without the influence of a vaccine, than rheumatic fever. Rheumatic fever has all but disappeared from industrialised countries after being a frequent problem in the 1940s and 1950s. That the disease still occurs at high incidence in resource limited settings and in Indigenous populations in industrialised countries, particularly in Australia and New Zealand, is an indication of the profound effect of socio-economic factors on the disease. Although there have been major changes in the epidemiology of rheumatic fever, diagnosis remains reliant on careful clinical judgement and management is remarkably similar to that 50 years ago. Over the past decade, increasing attention has been given to rheumatic fever and rheumatic heart disease as public health issues, including in Australia and particularly in New Zealand, as well as in selected low and middle income countries. Perhaps the greatest hope for public health control of rheumatic fever is the development of a vaccine against Streptococcus pyogenes, and there are encouraging initiatives in this area. However, an effective vaccine is some time away and in the meantime public health efforts need to focus on effective translation of the known evidence around primary and secondary prophylaxis into policy and practice.

The Clinical Value of Ficolin-3 Gene Polymorphism in Rheumatic Heart Disease. An Egyptian Adolescents Study

“…Rheumatic fever (RF) is a public health care burden in low-income and developing countries, where the highest prevalence of RF exists, especially in children and young adults. RF is a consequence of recurrent group-A Streptococcus pyogenes (GAS) pharyngitis as an immune-mediated complication in individuals genetically susceptible [1,2].…”

Incidence of acute rheumatic fever and rheumatic heart disease in Melbourne, Australia from 1937 to 2013

“…The decline in ARF may result from improvements in socio-economic conditions and better access to antibiotics to treat GAS infections, thus reducing the ARF risk for the general population. 7 RCH's status as a major cardiology and cardiac surgery provider likely meant that very unwell children from outside Victoria were referred for treatment, particularly after the new millennium. The persisting burden of ARF/RHD among Indigenous Australian children is important and inequitable.…”

“…22 The changes in incidence we detected over the study period largely mirror those observed for European and North American populations overseas. 6,7 An increase in ARF during the 1940s was documented in Denmark, but by 1962 the incidence had fallen to 12 per 100 000 population. 23 In the United States, ARF was so common that there were long waiting lists for specialised hospitals in 1946, and from 1960 to 1964 the incidence of ARF was 26 per 100 000 children aged 5-19 years.…”

“…ARF has frequently been associated with features of socio-economic deprivation. 7 Predisposing genetic risk markers have inconsistently been identified in some at-risk groups. ARF is nowadays considered a disease of social injustice.…”

Genetic Basis of Myocarditis: Myth or Reality?

“…Rheumatic fever (RF) is an immune-mediated disease that affects predominantly children and adolescents in low-income and developing countries, in which the disease burden is still relevant [92,93]. RF occurs in "genetically susceptible individuals", as sequelae of Group A Streptococcus (GAS) pyogenes infection.…”