Suggested reasons for the decline of rheumatic fever in industrialised nations2
| Reasons | Possible mechanism of benefit | Evidence |
| Improved standards of living | • Less overcrowding • Improved nutrition | • Declining incidence of RF before the antibiotic era |
| Greater access to health care and widespread use of antibiotics |
• Prompt treatment of symptomatic streptococcal infections • Reduced occurrence of epidemics of streptococcal sore throat • Prevention of recurrence of RF through secondary prophylaxis | • Studies examining the effect of improved health care availability in poor urban areas • Fourfold decline in reported national mortality from RF after introduction of penicillin |
| Diminished streptococcal virulence and fewer “rheumatogenic” subtypes | • Less rapid spread of streptococcal infections • Reduced prevalence of specific “rheumatogenic” strains | • No direct evidence, diminishing incidence of RF in the face of unchanged prevalence of streptococcal infection |
RF, rheumatic fever.