Control of Rheumatic Fever: How Are We Doing?

The American Heart Association has recently published updated recommendations for the prevention of acute rheumatic fever.1These recommendations are essentially the same as those first published 24 years ago2; the major differences are a consequence of the development of injectable penicillin G benzathine and of erythromycin, and the demonstration that group A streptococci frequently exhibit resistance to the tetracyclines. The similarities indicate that there have been very few changes in our approach to the control of rheumatic heart disease since it was first shown that acute rheumatic fever can be averted by appropriate treatment of the inciting streptococcal infection and that recurrent rheumatic fever can be prevented by continuous prophylaxis. We still do not know how to predict among those with streptococcal infections who are at risk for rheumatic fever, how to distinguish streptococcal carriers from those with actual infection except in retrospect, or exactly how theStreptococcus