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Previous Volume 357:2089 November 15, 2007 Number 20 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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To the Editor: In his Perspective article on rheumatic heart disease in developing countries, Carapetis (Aug. 2 issue)¹ correctly notes the important contribution of improved living conditions to the decline in the incidence of acute rheumatic fever over recent decades in wealthy countries. However, he does not acknowledge the contribution of the very substantial decrease in the prevalence of highly rheumatogenic emm types of group A streptococci as causative agents of acute pharyngitis.

Our surveillance studies of pediatric pharyngitis group A isolates in the United States and Canada from 2000 through 2005 showed a striking disappearance of emm types 14, . . . [Full Text of this Article]

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