Recent advances in rheumatic fever control and future prospect: a WHO memorandum.

The public health importance of rheumatic fever is not directly related to its prevalence but is a complex function of many factors, such as incidence, prevalence, mortality, disability, and cost to the community, all relative to the importance of other diseases. Although the prevalence is low and still decreasing in developed countries, rheumatic fever is the commonest form of heart disease in many developing countries. Advances in the bacterial and serological characterization of group A streptococci are reviewed in this Memorandum, with emphasis on the nature of the structural elements of the cell wall. Microbiological methods play an important role in the diagnosis and control of rheumatic fever and up-to-date information is given concerning methods of isolation and grouping and of typing. Methods of assessing streptococcal activity in the host, in particular the different antibody responses found in relation to different pathological conditions, are discussed, as are the improvements required in laboratory services to enable them to carry out these duties adequately. Current concepts concerning the pathogenesis of rheumatic fever are reviewed together with differences in the epidemiology related to the different sites of infection and the problems of carriership. The Memorandum is also concerned with the methods of prevention and treatment, including prevention of recurrences, control of the disease in communities, and strategies for nationwide control.