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The Incidence of Acute Rheumatic Fever in the World: A Systematic Review of Population-based Studies
  1. Kemilembe B Tibazarwa (kemilembe.tibazarwa{at}
  1. University of Cape Town, South Africa
    1. Jimmy A Volmink (jvolmink{at}
    1. University of Stellenbosch, South Africa
      1. Bongani M Mayosi (bongani.mayosi{at}
      1. University of Cape Town, South Africa


        Background: Acute rheumatic fever (ARF) is a multi-organ disease triggered by infection with Lancefield Group-A Streptococci (GAS). Despite the effectiveness of antibiotic treatment of streptococcal pharyngitis in reducing the incidence of ARF, developing countries continue to experience a high burden of the disease and its chronic sequel, rheumatic heart disease (RHD).

        Aim: To summarise all population-based studies of the incidence of ARF worldwide.

        Method: A systematic review of all published prospective population-based studies of the incidence of first episode of ARF was conducted. The outcome measures were overall mean incidence rate of first attack of ARF per year (calculated over the entire study period for each study), and annum specific incidence rate (for studies documenting cases for each year of study).

        Results: A search of MEDLINE, EMBASE, and other health-related databases identified 10 eligible studies conducted in 10 countries on all inhabited continents, except Africa. The overall mean incidence rate of first attack of ARF ranged from 5 to 51/100,000 population (mean 19/100,000; 95% confidence interval (CI) 9-30/100,000). A low incidence rate of „T10/100,000 per year was found in America and Western Europe. By contrast, a higher incidence (>10/100,000) was documented in Eastern Europe, Middle East, Asia, and Australasia. Yearly incidence rates were highest in the Middle East. Studies with longitudinal data displayed a falling incidence over time.

        Conclusion: Despite an apparent fall in incidence over time, ARF incidence rates remain relatively high in Eastern Europe, the Middle East, and Australasia. Studies of ARF incidence are required in Africa, a continent that bears a high burden of RHD, and yet has no reliable information on ARF incidence rates.

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