Abstract
We thank the correspondents for highlighting the importance of primary prophylaxis as part of a comprehensive rheumatic heart disease control strategy. In correspondence with these same authors previously, one of us (J.R.C.) pointed out that there is no convincing evidence that primary prophylaxis, of itself, will effectively reduce the incidence of acute rheumatic fever (ARF) in a population.1 Instead, we take a similar approach to the authors in advocating for a range of strategies for rheumatic fever control, including primordial, primary, secondary, and tertiary prevention, along with general awareness-raising in the community and among health staff. However, …
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