Response to Letter Regarding Article, “Is Primary Prevention of Rheumatic Fever the Missing Link in the Control of Rheumatic Heart Disease in Africa?”

Abstract

We thank Dr Carapetis for his comments on our article. Ourstatement relating to arguments against adopting primary antibioticprophylaxis for the prevention of rheumatic fever and rheumaticheart disease as a public health intervention in the community hasbeen misunderstood. Taken in context, our statement refers only tothe relative importance given to a strategy of primary preventionvis-a˘-vis secondary prevention in the literature. We apologize to DrCarapetis and any others who feel that we have misrepresented theirposition. This was definitely not our intention, and we do hope thatreaders will view our statement within the context of our broaderargument.Throughout the article we have repeatedly emphasized the needfor a strategy of primary prophylaxis only as part of a comprehensiverheumatic heart disease control program that includes secondaryprevention, and we have diligently avoided “making specific claimsabout the likely effectiveness at the population level of primaryprophylaxis alone.”