In Baltimore from 1960 to 1964, 18% of all patients hospitalized for acute rheumatic fever were adults. The average annual incidence of hospitalizations for acute rheumatic fever in adults aged 20 to 39 years was 3.1 per 100,000, approximately one fifth the rate in children and adolescents in the same community. Incidence rates were higher among nonwhites than whites, particularly for recurrent attacks. None of the adults with a recurrence was receiving regular prophylaxis at the time of his attack. Seven of the 12 patients with recurrences had no history of clinical symptoms relating to prior upperrespiratory tract infection. The data indicate that both initial and recurrent attacks of acute rheumatic fever continue to occur in adults, and emphasize the importance of maintaining continuous antistreptococcal prophylaxis in the young adult rheumatic population.
Gordis L, Lilienfeld AM, Rodriguez R. A Community-Wide Study of Acute Rheumatic Fever in AdultsEpidemiologic and Preventive Factors. JAMA. 1969;210(5):862–865. doi:10.1001/jama.1969.03160310050009