Organization Rheumatic Fever and Rheumatic Heart Disease Report of a WHO Expert Consultation, 29 October–1 November 2001 WHO technical report series No 923 Geneva: WHO; 2004; and Gerber MA, Baltimore RS, Eaton CB, et al Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research Circulation 2009;119:1541–1551 One of the main concerns is the adherence of patients to the prophylactic regimens As a consequence of the use of a medication involving painful administration or daily oral therapy for long periods of time, sometimes compliance with prophylactic regimens can constitute a challenge, mainly in adolescents Another reason to discontinue prophylaxis would be incomplete information about the disease and the need of prevention, besides the fear of allergic reactions Anaphylaxis, however, is a rare event, and the great majority of cases of hypersensitivity are represented by mild reactions, mainly skin rashes The risk of a serious complication is lower in children than in adults, and long-term prevention does not appear to increase the risk of an allergic reaction.35,232,233 To improve compliance with the prophylactic regimen, it is important to plan the follow-up with patients and families Information must be given about the importance of the continuous medication, and why it is necessary to prevent subsequent streptococcal infections Prevention of RF involves more than only the prescription of antibiotics At a population level, the integration into a wider health system with an active engagement of the primary health care staff can increase the chances of a timely diagnosis In any suspicious case, before starting prophylaxis, an accurate diagnosis must be made, and this action depends on global access to the health system and trained healthcare providers Surveillance, strategies to reduce injection pain, a close communication, and provision of education to patients and families are complementary actions to promote adherence to prophylaxis regimens and follow-up.226 Acknowledgment We are indebted to Luiza Guilherme, for reviewing the text in the light of her specific areas of expertise Annotated References World Health Organization Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation WHO: Geneva; 2004 Geneva, 29 October–1 November 2001 WHO technical report series No 923 This technical report from the World Health Organization comprises a complete and updated review of the epidemiologic, pathogenetic, clinical, therapeutic, and prophylactic aspects of rheumatic fever and its cardiac sequels, with an extensive list of references Carapetis JR, Steer AC, Mulholland EK, Weber M The global burden of group a streptococcal diseases Lancet Infect Dis 2005;5:685–694 The authors evaluate the burden of diseases caused by group A Streptococcus on a global scale according to a review of population-based data, highlighting the importance of developing strategies for prevention It is estimated that more than 336,000 cases of rheumatic fever occur in those aged from 5 to 14 years, and an annual number at more than 471,000 for all ages About three-fifths of the cases, about 282,000 patients, are expected to develop