Paonc Hrnlrn Drnroc Vor 5, No. 1 Vrewpolrlrs nno Prnsprcnvrs
i n t r a m u s c u l a r b e n z a t h i r . r e p e n i c i l l i n , o f a p o p u l a t i o n o r s i t e known to have a high ir.rcider-rce of ARF or prevalence of RH D.
T h i s c o u l d b e s c h o o l - b a s e d i r . r s e l e c t e c l v i l l a g e s , r n u n i c i p a l i - t i e s o r i s l a n d s f o u n d t o h a v e a h i g h r a t e a f t e r in s t i t u t i n g m e a s u r e 1 ,2,3, and 4. Sirnilar t o I n e a s u r e 5 , b u t e v e n m o r e aggressive, the purpose is to reduce the populatior.r burden of streptococcal carriage and infection. This is tLrrrr will reduce t h e n u m b e r o f p e o p l e w h o g e t A R F o r R H D .
A l t h o u g h i t r n i g h t a l l p e a r t o b e e x t r e r n e , s u c h a p o l i c y h . t s b e e n s u c c e s s f u l i r r c o r n p a r a b l e s e t t i r . r g s e l s e w h e r e . T r o lt seefits especially altproltriate in the srnilll geogrillthically isolated population of the Pacific. lt is, in principle, not very different frorn other poltul;ition-bilsed strategies to recluce t h e b u r d e n o f d i s e a s e s u c h a s th e u s e o f u n i v e r s a l p r o p h y l a x i s with vitarnin A, verrlox or diethylcarbalrazal)ilre for vitarnir.r A deficiency ancl ascari;,rsis in high ltrevaler.rce popr.rlations. lt can even be cornp:rred to
irnrnunization agair-rst vac- c i t t e p r e v e t t t a l r l e t l i s e . r s t ' s w l r e r e t h e r i s k o f r l i s e . r s e t o . , r r r y s i n g l e i r r r l i v i c f t r , r l i s l o w , i b u t u n i v e r s . r l c o v e r . r g e i s , sought to protect the popu- : l a t i o n . lt a l s o h a r k e n s b a c k : to the P.rcific expcrience with i t h e e r . r d i c , r t i o r r o f v , r w s . ; This is admitteclly il ve-ry : . r g g r e s s i v e s t e l ) t o l , t k e , , r r r r l , w o u l d b e s t L r e rl o r r e .r l t e r I n e . r s u r e s I - 4 h , r v e I r e e r r i n t .
w e s h o u l d a l s o a c k n o w l e d g e t h a t o t h e r i n d e p e n d e n t s o c i o e c o n o m i c a n d d e m o g r a p h i c c h a n g e s n o w d e s i r e d . . . a r e l i k e l y
t o c a u s e a n a t u r a l d e c l i n e i n t h e i n c i d e n c e a n d t r a n s m i s s i o n o f streptococcal pharyngitis and
h e n c e i n t h e i n c i d e n c e a n d p r e v a l e n c e o f A R F a n d R H D .
hold and school size arrd crowding, and imltroved nutrition, ventilatior.r ar.rd sanitatiolt - are likely to cause a natural decline in the ir-rcidence and transrnissior.r of streptococcal p h a r y n g i t i s a n d h e n c e i n th e in c i d e n c e a n d p r e v a l e n c e o f A R F a n d R H D .
References
1 AIto W, Rikin T, FalanrLrw W, et al. Rheunratic Fever rn Micronesia . Pacifu' Hc;tltlt Dialog. 1994;1 .
2. WHO Carcliovascular [Jnit, et al. WHO Progr.rnrnre for the preventiorr of rlreurtratic fever/ rlteuntatic he.rrt clise.tse in 16 developing countries: report fronr phase | (1986-90). Bull WHO 1992;70:213-218.
3 . M c l a r e n M J , H a w k i n s D M , K o o r n h o f H J , e t a l . E p i d e n r i o l o g y of rheunratic heart disease in ltl.rck school children of Soweto, f o l r a n n e s b u r g . B r M e t I J 1 9 7 5 ; 3 : 4 7 4 - 4 7 7 .
'1. Argarw.rl Bl . Rltt:trrn.ttrc lrc-.rrt <lise.rse urritb.rterl in cle v e l o p i n g c o t r r r t r i e s . / ; r r r r c l
1 9 8 l ; ) . 9 1 0 - 9 1 l
5 . F o r 1 9 9 L C . r l c L r l a t e d b y A u e r l r . r c l r S B fr o n r t l . r t . r r r r a i r r - t a i n e d b y t h e K o s r . r e a r r d P o h n p e i D e l r a r t n t e n t s o f lle.rlth Services, FSM. Agr'- spccifir' 5lalc p o1 t uIat i or rs f ron't tlx' FSM offict' ti Plarutrng,trtt I -5l.ttlslir.s.
6. Arguerclas A & Molrs E. Pre- vention of rlreunratic fever lrr C o s t . r R i r , r . J P ' , t l r t t t t , s 1992;121 569-72
I
1 0 plernented and in conjur.rction with ;r study nteasLrnng pre- and post- streptococcal cilrriage i,rr.rcj irrfectiorr rates ancl rates of ARF. There will inevitably be sorne rernainit.rg cases of streptococcus and sorrrc sr"rbsecluent reirrtroduction frorn o u t s i d e p o p u l a t i o n s . H o w e v e r t h e p r e v a l e n c e a n d b u r c J e n o f s t r e p t o c o c c a l i n f e c t i o n s , A R F a n d R l I D r v i l l d e c l i n e . l t i s li k e l y that the rates woulcl never reach their ltrior high levels.
Finally, we should also ackrrowledge that other ir.rclepend- ent socioeconornic and dernographic changes r.row desired a n d s o u g h t i n r r o s t P a c i f i c j u r i s d i c t i o n s - such as decreased birthrates, increased childbirth spacir.rg, decreased house-
Ath.r M. How an Arleric.ln lndian tribe controllecl the streptococclrs. Workl Ht'itltlt Forunt 1982;3.423-428.
Brant L.l, et al. Ev;lluation of an Alaskan streptococcal corrtrol progr(rnt: intportance of tlre progrant's intensity and duration.
Prtv Mt<t 1986;15 632-64).
Coulelran J, et al. Acute rlreunr.rtic fever and rheuntatic he;rrt dise;rse on the Navajo reserv.rtion, 1962-77 Pultlic Hr';tlth Rcporl.s. 1 980;95:62-68.
Phibbs B, et al. Erperience of a Wyonring country streprococ- c.rl corrtrol project. West J Mrtt 19BB;1 48:546-550. fJ
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After 20 years one is no longer quoted in medical literature.
Every 20 years one sees a re-publication of the same ideas.
Bela Schick (1886 - 1947)
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