CHANGES IN THE PREVALENCE OF ACUTE RHEUMATIC FEVER IN SOUTHERN IRAN

Background-Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are still two major public health problems in Iran. Our objective was to assess the status of acute rheumatic fever in children and adults admitted to four major teaching hospitals during the last 20 years. Methods-The number of annual hospital admissions of patients coded as ARF from March 1979 to March 1998 was obtained from medical records. The diagnosis of ARF was confirmed only if the patients fulfilled the modified Jones Criteria. The presenting signs and symptoms and the annual in-hospital prevalence were determined and the annual incidence per 100,000 cases hospitalized was calculated. Results-There were 675 cases with ARF of which 585 were initial and 90 were recurrent attacks. Female to male ratio was 3:4. The age of the patients was 15.4±7.5 years (mean±SD) with a range of 4 to 78 years. The groups most at risk were children and young adults aged 6 to 20 years (n=364). The major presenting complaints included polyarthritis (92.44%), carditis (57.48%), chorea (4.6%), erythema marginatum (1.9%) and subcutaneous nodules (0.15%). The attack rate was higher between the years 1979 and 1995 and lower thereafter. Conclusion-The changing pattern of the frequency of ARF during the last few years might be attributed to an improvement in the status of education and awareness in the general population, availability of a larger number of physicians in the primary health care settings, especially in rural areas, and earlier diagnosis and treatment of patients suspected with streptococcal pharyngeal infection.