Heredity, infection and chemoprophylaxis in rheumatic carditis: an epidemiological study of a communal settlement

Abstract

1. Children and their parents in a communal settlement (kibbutz) were followed for 14 months with special regard to the influences of streptococcal carrier rate, streptococcal infections, chemotherapy and heredity on the pattern of rheumatic heart disease.2. Children with proven or probable heart disease showed the same streptococcal carrier rates as controls in spite of continued chemoprophylaxis with oral penicillin.3. A single injection of penicillin, given to all kibbutz members on the same occasion, reduced the streptococcal carrier and infection rates to zero and maintained a marked drop for 3 months. Thereafter, the rates rose to higher levels than before. Courses of sulphamethoxypyridazine (‘Lederkyn’) given first to the total population and then to children only, caused only temporary interruption in the attack rate.4. The prevalence of rheumatic heart disease in children of parents themselves affected was 2½ times greater than in controls exposed to the same environmental risks.5. Affected children were more susceptible to streptococcal infections than controls with identical exposure.Grateful thanks are due to Miss Pearl Weiskopf, B.Sc., for the statistical analysis. Without the close collaboration of Dr J. Yauluss, Nurses Tova and Ziva and the members of Kibbutz S this study would have been impossible. Thanks are also due to Lederle Laboratories Department of Cynamid International and their Israeli agent, Dr L. Goldshmidt, for the gift of ‘Lederkyn’, and to Mrs Rachel Kosh for help beyond the call of her secretarial duties.