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Although rheumatic fever would seem to be an eminently preventable disease, given the fact that prompt penicillin treatment of streptococcal infections is effective, the fact remains that the disease is still with us. Probable reasons include failure of patients to seek or find medical care, inapparent infection, failure to diagnose and treat apparent infection, failure to administer penicillin for a sufficient length of time in cases of diagnosed infection, and failure to prevent recurrent attacks because of inadequate prophylaxis.
Brownell and Bailen-Rose (224:1593-1597, 1973) describe a study of children residing in Manhattan where the New York City Department of Health has operated a rheumatic fever program since 1952. During the years 1963 through 1965, there were 347 children with verified initial or recurrent episodes of the disease. By the time the authors' study was halted in early 1970, these children had had 413 attacks, 298 being initial and 115 recurrent.
Rheumatic Fever Control. JAMA. 1973;226(2):190-191. doi:10.1001/jama.1973.03230020040013