What is the global prevalence of acute rheumatic fever (ARF)?

Updated: Dec 10, 2020
  • Author: Robert J Meador, Jr, MD; Chief Editor: Herbert S Diamond, MD  more...
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Worldwide, as many as 20 million new cases of ARF occur each year. The introduction of antibiotics has been associated with a rapid worldwide decline in the incidence of ARF. Currently, the incidence is 0.23-1.88 patients per 100,000 population. From 1862-1962, the incidence per 100,000 population declined from 250 patients to 100 patients, primarily in teenagers.

Most major outbreaks occur under conditions of impoverished overcrowding where access to antibiotics is limited. Rheumatic heart disease accounts for 25-50% of all cardiac admissions internationally. Rates of rheumatic heart disease and releated deaths are particularly high in Oceania, South Asia, and central sub-Saharan Africa. [13] Some areas of South America are also strongly affected. [14]

Rates of ARF are exceptionally high in natives of Polynesian ancestry in Hawaiian and Maori populations. For example, in a study from a New Zealand district, the ethnicity of ARF patients was 85% Maori and 10% Pacific. Although the annual incidence of ARF was 3.1 per 100,000 population, in Maori children aged 5-14 years the incidence was 46.1 per 100,000 population. Almost three-quarters of all patients lived in severely socioeconomically deprived areas. [15] In Australia, the age-standardized first-ever rates of ARF were 71.9 per 100,000 population for indigenous populations, compared with 0.60 per 100,000 for non-indigenous populations. [16]

In the last decade, an increase in the incidence of ARF was observed in Slovenia, in south-central Europe. From 2008 through 2014, the estimated annual incidence of ARF was 1.25 cases per 100,000 children. [17]

A study of pediatric patients (age 0-17 years) in Lombardy, Italy who were hospitalized with the diagnosis of ARF from 2014 to 2016 found that the annual hospitalization rate was 4.24 cases per 100,000 children. A seasonal trend was evident, with fewer cases in the autumn and a peak in the spring. [18]

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