Abstract
During the past 25 years, there has been a dramatic decline in the incidence of acute rheumatic fever (ARF) in the United States and other economically developed countries. See also p 730. This unexplained decline actually began before the introduction of antibiotics for the treatment of group A streptococcal pharyngitis. The perplexity of this phenomenon is compounded by the lack of strong evidence of a comparable decrease in the background activity of group A streptococcal pharyngitis. The decrease in the incidence of ARF has been ascribed to such events as improved nutrition in children, improvement in the general standard of living with a decrease in crowding within families, and better health care availability for the diagnosis and treatment of streptococcal pharyngitis. In inner-city Baltimore, comprehensive health care appeared to be associated with the decline between 1960 and 1970 of first attacks of ARF in blacks with clinically overt acute pharyngitis.
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