Rheumatic fever and rheumatic heart disease in rural South Indian children.

A preliminary pilot study of streptococcal infection and sequelae was initiated in 23 villages in 1973 using trained field workers for case detection. Part of the pilot programme, in 1974-75, involved 374 rural and 664 urban schoolchildren, and revealed that 14.9% of them had streptococcal pyoderma while pharyngitis was seen in 4.2%. The pilot study also revealed a high prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD) in both rural (5.4/1000) and urban (6.0/1000) pupils. A long-term surveillance study was then undertaken in 3890 pupils attending 15 rural schools, from July 1975 to December 1978, when the prevalence of RF was found to be 0.5/1000 and of RHD, 4.4/1000, giving an overall rate of 4.9/1000. The incidence rate was found to be 1.7/1000 per year in 1976, 1.6/1000 per year in 1977, and 0 in 1978. The rate of compliance with primary prophylaxis was 90-100%, and with secondary prophylaxis was 92-93% of the 27 cases.