Global Strategies for the Control of Rheumatic Fever

The global disparities in the prevalence of rheumatic fever¹ are a vivid reminder of the relation of high standards of housing and health care to control of the disease. Rheumatic fever still ranks as a major health problem in large segments of the populations of Asia, Africa, and South America.² In fact, the industrialization of some native or aboriginal Third World populations has resulted in an alarming prevalence of rheumatic fever, estimated to be increasing in some provinces of South Africa.^2-4 These estimates actually exceed rheumatic fever incidence rates of 61/100,000 per year calculated for Manhattan schoolchildren between 1963 and 1965, a time when the disease's incidence was already declining rapidly in the United States. In this issue of JAMA (p 895), Land and Bisno report their conscientious effort to determine the incidence of acute rheumatic fever in Memphis-Shelby County, Tennessee, for the years 1977 through 1981.