Acute rheumatic fever in Hawaii: 1966 to 1988.

Seventy five children with acute rheumatic fever (ARF) were hospitalized on Oahu from 1984 to 1988. The annual incidence rate was 9.5 (all rates are per 100,000 children per year). The first attack and recurrent attack rates were 7.9 and 1.6. Polyarthritis occurred in 84%, chorea in 7%, and carditis in 32%. Mitral insufficiency was the most common valvular lesion (88%). Hawaiians/part Hawaiians and Samoans had the highest incidence rates (relative risk 3 and 56, respectively). Polynesian children were 84 times more likely to develop carditis. Five hundred thirty nine ARF cases were hospitalized on Oahu, 1966 to 1974 and from 1976 to 1988. The annual incidence rate of ARF on Oahu has remained fairly constant at about 12.4. The incidence rates in all ethnic groups have decreased except in Samoan children.

Acute rheumatic fever with advanced degree AV block.

Five cases are described of acute rheumatic fever meeting the modified Jones criteria with evidence of second or third degree atrioventricular block (AVB). One patient required a temporary transvenous pacemaker and two patients were treated with corticosteroids. One patient had an associated valvulitis. There was no long-term sequelae due to the AVB in any of the patients. The duration of the advanced degree AVB had a range of about 2 to 12 days. The cause of this advanced degree AVB is uncertain. Advanced degree AVB with acute rheumatic fever appears to be self-limited in most instances. Unlike rheumatic valvulitis, it is not associated with significant permanent morbidity.

Human monoclonal antibodies reactive with antigens of the group A Streptococcus and human heart.

Human mAb were produced from tonsillar or PBL of normal individuals or patients infected with group A streptococci. Lymphocytes were purified on Ficoll-Hypaque gradients and stimulated in vitro with purified group A streptococcal membranes or M protein extracts. The mAb were selected for study based on their reaction with group A streptococci, pep M5 protein, and/or M6 Escherichia coli protein. Further analysis by Western immunoblot or competitive inhibition ELISA revealed that there were two types of antibodies: one type that reacted with myosin and DNA and the other type that reacted with myosin, keratin, and/or actin. The specificities of these human mAb are similar to specificities observed in our previous studies of murine mAb reactive with group A streptococci and heart Ag. For comparison, anti-myosin antibodies were affinity purified from the sera of infected or acute rheumatic fever patients and were shown to react with myosin and DNA as well as with group A streptococci and M protein. To affinity purify these antibodies from normal sera, five times the amount of sera was required to obtain detectable quantities. These data suggest that the human mAb reactive with group A streptococci and myosin reflect the antibodies seen in sera from infected patients or acute rheumatics and that the B lymphocyte clones capable of producing these cross-reactive antibodies are also present in normal individuals.

Rheumatic fever in children and adolescents in Hawaii.

Case records of hospitalized children (age 4 to 18 years) with acute rheumatic fever on Oahu, HI, were reviewed for the 4-year period from Oct 1, 1980, to Sept 30, 1984. Ninety-eight cases met the modified Jones criteria. The overall incidence of rheumatic fever was 13.4 hospitalized children per 100,000 children per year and that for recurrent attacks was 2.5. Of the 98 with rheumatic fever, 73 had polyarthritis, 33 had carditis, and ten had chorea. Polynesian/part-Polynesian children accounted for 76 of the 98 cases. The incidence of rheumatic fever in Hawaiian/part-Hawaiian was 18.0 and for Samoan children was 206 hospitalized children per 100,000 per year. The relative risks were 7.7 and 88 times that of the white children, respectively. Rheumatic fever continues to cause significant morbidity in children in Hawaii, especially in Polynesian children.

Occurrence and prevention of rheumatic fever among ethnic groups of Hawaii.

To assess the occurrence of acute rheumatic fever (RF) among the ethnic groups of Hawaii, the case records of hospitalized children with RF in Oahu were reviewed for the period from October 1976 to September 1980. One hundred four of the records met the modified Jones criteria. Incidence rates per 100,000 children were as follows: Japanese, 0; white, 9; Filipino, 9.1; Hawaiian and part-Hawaiian, 27.2; and Samoan, 96.5. Carditis was most common among Samoan children; it occurred in nine of 18 children. A streptococcal, throat culture program for children with respiratory infections was in progress in 60% of Oahu's public schools during this period of time. Children with positive cultures were excluded from school until the start of treatment. However, RF occurred with equal frequency in participating and nonparticipating schools. Rheumatic fever continues to be a substantial problem among Polynesian children in Hawaii, and it is apparent that the school-based primary prevention program used in Hawaii to control streptococcal disease has not altered the frequency of RF among them.