I became fascinated with rheumatic fever and rheumatic heart disease about 10 years ago as I noticed certain parallels to childhood diabetes (LaPorte, Baba, Diabetes Care, 1992, 15:128-131). These were basically very similar diseases, having the same incidence in 1960. The major difference was that rheumatic fever in the US and much of the world has markedly decreased, however childhood diabetes continues to rise. This could be a clue as to how to prevent childhood diabetes.

Rheumatic fever is extremely interesting as that it is an Human Leukocyte Antigen (HLA) associated disease, with antibodies, thus a classical autoimmune chronic disease, yet most people consider it an infectious disease. Moreover, it is a fascinating chronic disease in that unlike practically any chronic diseases, it decreases with increasing socioeconomic status.
It is also fascinating as it is one of the few autoimmune chronic diseases where both the genetic factors (HLA) and the environmental factors (group A Streptococci) are known. Moreover the immunologic events leading to the disease through superantigen are beginning to be worked out.

Reading the epidemiology of RF/RHD in the 1940s-1960s provides very important insight as to how we can prevent other HLA associated autoimmune diseases such as childhood diabetes, rheumatoid arthritis, lupus, Hodgkins disease, Multiple Sclerosis, etc.

The lecture is designed to describe how the etiology of RF/RHD is being untangled using epidemiology and molecular epidemiology approaches. It describes a major success story, something of which we can use in the prevention of other serious autoimmune diseases. Epidemiology has lead the way for prevention.

Forty years ago rheumatic fever/heart disease was the major killer of children worldwide. Now in developed countries most physicians will never see a case. If we can do this with rheumatic fever, we can also do it with many other HLA associated diseases.