Table 1

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.