Observations on the epidemiology and preventability of rheumatic fever in developing countries

Rheumatic fever is no longer a significant health problem in socioeconomically advanced countries, but it still causes 25% to 40% of all cardiovascular disease in the rest of the world, including tropical countries where it was once believed to be rare. Differences in clinical manifestations may have obscured the rheumatic fever syndrome in the past, but there is reason to believe that the incidence of the disease has increased with urbanization. In any event, carditis is severe and frequently leads to advanced heart disease. Rheumatic fever is, to a large extent, preventable. Obstacles to effective prevention programs are discussed.