Reappearance of rheumatic fever.

Even though incompletely understood, much of the information about the epidemiology and pathogenesis of rheumatic fever has become available only in the last few decades, a time when there have been significant fluctuations in rheumatic fever and rheumatic heart disease in the United States. The precise roles of the bacteria, the human host, and the environment and their interrelationships require more study. Determining their roles and defining the pathogenesis can have important practical application. If one could identify a susceptible population, if one could identify the serotypes and/or strains of group A streptococci that are more dangerous (rheumatogenic) and if one could identify the reason for an abnormal immune response, vaccines might be made with specific protective components of the group A streptococci and administered only to known susceptible individuals. Providing optimal public health programs to control a disease that still is a major problem in a large segment of the world's population is the goal. It is quite clear from the resurgence of acute rheumatic fever in the United States in the mid-1980s that antibiotics alone are not the answer to rheumatic fever control. If antibiotics are not completely effective in a country such as the United States, they cannot be expected to be effective in many of the developing countries of the world where primary health care delivery is even more difficult. Intensified efforts to understand the pathogenetic mechanisms responsible for the development of rheumatic fever should be undertaken. In the meantime, the preventive methods that are available should be vigorously applied.