The resurgence of acute rheumatic fever in the United States.

The incidence of acute rheumatic fever (ARF) had been declining in the United States for decades, and by the late 1970s ARF had become a rare disease in most areas of the country. The mid-1980s saw a resurgence of ARF, with reported outbreaks in Utah, Ohio, Pennsylvania, and military recruit camps in Missouri and California, as well as sporadic cases in many other communities. This review summarizes salient epidemiologic data related to the resurgence, explores some possible explanations for its occurrence, and discusses strategies for prevention of rheumatic fever now and in the future.