During the past 25 years, there has been a dramatic decline in the incidence of acute rheumatic fever (ARF) in the United States and other economically developed countries. See also p 730.
This unexplained decline actually began before the introduction of antibiotics for the treatment of group A streptococcal pharyngitis. The perplexity of this phenomenon is compounded by the lack of strong evidence of a comparable decrease in the background activity of group A streptococcal pharyngitis. The decrease in the incidence of ARF has been ascribed to such events as improved nutrition in children, improvement in the general standard of living with a decrease in crowding within families, and better health care availability for the diagnosis and treatment of streptococcal pharyngitis. In inner-city Baltimore, comprehensive health care appeared to be associated with the decline between 1960 and 1970 of first attacks of ARF in blacks with clinically overt acute pharyngitis.
Ferrieri P. Acute Rheumatic Fever: The Come-back of a Disappearing Disease. Am J Dis Child. 1987;141(7):725–727. doi:10.1001/archpedi.1987.04460070027011
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