[Changes in the incidence and clinical picture of rheumatic fever in 6 communities in the Istrian Subregion (1962-1986)].

Two hundred patients up to 13 years of age who were admitted to the Department of Pediatrics, Pula, between 1962 and 1986 with acute rheumatic fever were studied. Of these patients, 21 (10.5%) were in relapse. During the first 12 years of follow-up, 177 patients were treated and during the last 13 years only 23 patients. The average hospital incidence declined from 2.7% in 1963 to 0.3% or less between 1975 and 1986. The average annual incidence of acute rheumatic fever in a group of patients aged 0 to 14 years decreased from 67/100,000 in 1963 to 5.4/100,000 children in 1986. Within the last 13 years of follow-up, no relapse was observed. From 1966, no patient with decompensation of the heart was treated; and from 1961, no mortality was observed as a consequence of acute rheumatic fever. There are a number of factors which influenced these good trends, such as advances in health protection of children, better primary and secondary antirheumatic prophylaxis and, of course, continued improving of the standards of living in this subregion. It is concluded that in spite of the declining incidence and milder course of acute rheumatic fever, the disease still remains a serious public health problem due to a possible cardiac damage.