Prevention of rheumatic fever: A statement for health professionals by the committee on rheumatic fever, endocarditis and Kawasaki disease of the council on cardiovascular disease in the young, the American Heart Association

Prevention of both initial and recurrent attacks of acute rheumatic fever depends on control of Group A beta-hemolytic streptococcal upper respiratory tract infections. These include tonsillopharyngitis (strep throat) and associated conditions such as otitis, sinusitis and mastoiditis. Prevention of first attacks (primary prevention) is accomplished by proper identification and adequate antibiotic treatment of these streptococcal infections. The individual who has suffered an attack of rheumatic fever is inordinately susceptible to recurrences following subsequent Group A streptococcal upper respiratory tract infections and needs continuous protection to prevent recurrences (secondary prevention). The current recommendations reflect the fact that the incidence of rheumatic fever remains quite low in most areas of the country. These recommendations may not apply to certain areas of the United States where sharp increases in incidence of rheumatic fever have been noted recently, or regions of the world that continue to have a high incidence of the disease. Reappearance of acute rheumatic fever in a specific geographic region should draw attention to therapeutic, preventive, and epidemiological measures as well as stimulate use of these recommendations.