Incidence of Acute Rheumatic Fever

The incidence of acute rheumatic fever has declined remarkably in the past three decades, but the disease has not been eradicated, as some physicians believe. This study documents the diagnosis of the disease in 23 middle-class children from Fairfax County, Virginia, during the 11-year-period from 1970 through 1980. This county has one of the highest median family incomes in the United States. The annual age-adjusted incidence rate of initial attacks of acute rheumatic fever per 100,000 Fairfax County children declined from 3.0 in 1970 to 0.5 in 1980. In six of the 23 children, carditis accompanied by monarticular arthritis or arthralgia was present. Another seven children had carditis plus polyarthritis. Two patients had Sydenham's chorea. None of the children had erythema marginatum or rheumatoid nodules. In two children, symptoms of acute rheumatic fever developed two weeks after they finished a 10-day course of penicillin for Group A streptococcal pharyngitis. The remaining 21 children had not been considered ill enough to be brought to medical care prior to development of symptoms of acute rheumatic fever.