Prospects for Group A Streptococcal Vaccine

Abstract

Although the attack rate of acute rheumatic fever has declined dramatically in the industrialized nations of the world, it remains a rampant disease in third world countries and continues to be the major cause of heart disease in children around the world. Indeed, the prevalence rates of rheumatic heart disease in school-aged children is as high as 33 per thousand in the urban slums of some developing countries (Kholy et al., 1978). A number of programmes have been undertaken for the prevention and control of rheumatic fever and rheumatic heart disease in various regions around the world. The major emphasis of these programmes has been on secondary prevention, including long-term antibiotic prophylaxis to prevent recurrent attacks of acute rheumatic fever. Primary prevention programmes directed toward prevention of the initial attack of rheumatic fever also have been instituted, but with less success. These have emphasized early diagnosis of streptococcal infections with prompt antibiotic treatment of the acute infections. Inasmuch as the diagnosis of streptococcal infections is often difficult to make in many parts of the world, and mass antibiotic prophylaxis is impractical if not impossible, the primary prevention programmes have been far from successful.