The Rise and Fall (and Rise?) of Rheumatic Fever

The dramatic decline in incidence of acute rheumatic fever in the United States during the past half century has been a truly remarkable phenomenon. During the years 1943 to 1945, for example, the incidence of the disease among army personnel stationed in the northeastern United States was 388 per 100 000. As recently as the mid-1960s, rates of approximately 25 to 35 per 100 000 population were recorded among school children in midsized American cities such as Baltimore and Nashville, Tenn. Yet surveys conducted within the past decade in several geographic locales from coast to coast have recorded rheumatic fever incidence rates in the range of 0.5 to 1.88. The experience has been similar in the other highly developed countries of Europe and North America. These facts were commented on in a recentJAMALandmark Perspective, "The Rise and Fall of Rheumatic Fever,"¹and were the subject of a