Prevention of first attacks of rheumatic fever

Abstract

The prevention of recurrences is very useful indeed to patients after a first attack of rheumatic fever but will never, by definition, eradicate the disease from the population at large. Moreover, many children suffer severe, irreversible heart damage from their first attack of rheumatic fever: to them the triumphs of secondary prophylaxis are no consolation. In some countries it is acknowledged that “the initial attack of acute rheumatic fever is hardly ever diagnosed in our environment. In most cases… cardiac damage is already severe and death from cardiac failure, common”1. Hence the importance of preventing first attacks (primary prevention). Well-controlled studies in military populations have shown that 90% of first attacks can be prevented by adequate antibiotic treatment of the preceding streptococcal pharyngitis2 (see Table 2.1, p.10).