Lessons from the Recent Outbreaks of Rheumatic Fever in the United States

After declining in incidence for many years, rheumatic fever had an unexpected resurgence among middle-class children in the United States. The incidence of carditis was unusually high, and was more severe than had been seen in recent years. The most likely reason for the return of rheumatic fever was increased virulence of Group A streptococci and the reappearance of rheumatogenic strains of this organism. It is hoped that the experience gained from this resurgence will contribute to the development of a streptococcal vaccine and to the eradication of rheumatic fever, a major cause of heart disease in many areas of the world.