To the Editor: Wedum (April 11 issue)1 has suggested an association between rubella vaccination and the decline in the number of new cases of rheumatic fever in the United States. An analysis of the experience in Baltimore, however, reveals that the abrupt decline of rheumatic fever was in progress before the introduction of rubella vaccine and that the decline may be more closely related to the fall in the number of cases of measles. Gordis examined the incidence of rheumatic fever within four urban census tracts in Baltimore. The annual incidence was 26.8 new cases per 100,000 among children aged.
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