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Dr Garcia-Palmieri has very properly emphasized that the epidemiology of acute rheumatic fever relates to the intensity and severity of streptococcal disease, whether it be in the tropics or in temperate climates. Wherever the predisposing factors of inadequate primary medical treatment with crowded living conditions, close person-to-person contact, inadequate nutritional intake, and lowered host defenses exist, acute rheumatic fever can be expected—and the prevalence of rheumatic fever and rheumatic heart disease will not be related to climate, per se, nor to any particular racial or ethnic group.For further information, the reader is referred to the very excellent monograph Rheumatic Fever and Streptococcal Infection by Dr Gene H. Stollerman (New York, Grune & Stratton Inc, 1975).
Persellin RH. Rheumatic Fever in Warm Climates-Reply. JAMA. 1976;235(2):143. doi:10.1001/jama.1976.03260280011003
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