Rheumatic fever epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Epidemiology and Demographics
Rheumatic fever, and therefore Streptococus pyogenes infections, are endemic in all areas of the world. In countries affected by the industrial revolution, domestic living conditons became less crowded, due to the development of larger homes and families had fewer children. In addition, iving conditions became, generally, more hygienic. The introduction of antibiotics, first sulfonamide in the early 1930's and then penicillin in the 1940's, further caused Streptococcus pyogenes infections to become less common and less severe in economically developed countries although they never disappeared.
Rheumatic fever was a scorge of society for hundreds of years, until the post WW II era, for in the text, Rheumatic Fever and Streptococcal Infection (Massell, B., Harvard Press, 1997)the author indicates, "For the period 1939-1943, statistics published by the Metropolitan Life Insurance Company indicated that rheumatic fever was the leading cause of death among policy holders for persons from five to nineteen years of age and the second leading fatal disease among twenty to twenty-four year olds."
In north America, western Europe, Japan, much of Australia and New Zealand rheumatic fever became very uncommon. It decreased in frequency in modern western societies in a progressive fashion from the early 1900's, but it decreased remarkably after WW II so by 1970 it was thought to be a very rare disease in the USA, for instance, but it never disappeared. In certain populations such as the aboriginies of Austrialia and New Zealand it remained common and it also remained common in the aborigines of North America although it is not mentioned frequently in medical literature.
Rheumatic fever affects individuals who are thought to be "young and healthy", for instance, individuals between four years and fifty years of age, but during most eras rheumatic fever was most commonly noted in individuals between the six and thirty. The reason children younger than four years of age, or so, do not usually develop rheumatic fever is that an individual must have sufficient, prior stimulation by Streptococcus pyogens autoantigens, which is, typically, caused by multiple infections by Streptococcus pyogenes, over a relatively short period of time, and that situation is less likely to occur in younger children (although it does happen!). Older individuals are expected, somewhat, to develop diseases of aging and so it is often not surprising when they become sick; it is surprising when individuals in their teens, twenties, thirties, forties and even fifties, for instance, become very sick so those cases attract more "medical" attention. Individuals of all ages, however, can develop rheumatic fever.