Epidemiological approaches to understanding the pathogenesis of rheumatic fever.

Thus, in 1985, over four decades after discovery of the first important clue towards understanding the pathogenesis of rheumatic fever, medical science still has not defined the mechanism(s). Objective evaluation of available data from around the world indicates that penicillin alone will not lead to effective control. Furthermore, in geographical areas where streptococcal infections, rheumatic fever and rheumatic heart disease are most prevalent, it seems unlikely that standards of living will rise quickly enough to impact on the incidence of this disease during the next several decades. There is renewed worldwide interest in and emphasis on the implementation of rheumatic fever control programmes. The World Health Organization (WHO), in collaboration with the International Society and Federation of Cardiology (ISFC), is promoting a strategy to develop national programmes for the prevention of rheumatic fever and rheumatic heart disease. In 1984-5, designated by the ISFC as the Year of the Rheumatic Child, the WHO Cardiovascular Disease Unit initiated plans to collaborate with 15 developing countries in the development and implementation of rheumatic fever control programmes. Because of the inescapable conclusion that control methods are most efficiently applied when pathogenetic mechanisms are understood, additional epidemiological data should be collected to assist both basic scientists and clinicians in understanding more about this unique disease.