Sandbox Turky3
The development of a rheumatic fever episode depends on the involved host being highly autoimmunologically sensitized to autoantigens exhibited by Streptococcus pyogenes to its host during prior Streptococcus pyogenes infectious episodes, so a decrease in the frequency and virulence of infections by Streptococcus pyogenes in a society can cause rheumatic fever, as a disease entity, to be less frequent and less severe.
Rheumatic fever affects individuals who are thought to be "young and healthy", for instance, individuals between four years and fifty years of age, but during most eras rheumatic fever was most commonly noted in individuals between the six and thirty. The reason children younger than four years of age, or so, do not usually develop rheumatic fever is that an individual must have sufficient, prior stimulation by Streptococcus pyogens autoantigens, which is, typically, caused by multiple infections by Streptococcus pyogenes, over a relatively short period of time, and that situation is less likely to occur in younger children (although it does happen!). Older individuals are expected, somewhat, to develop diseases of aging and so it is often not surprising when they become sick; it is surprising when individuals in their teens, twenties, thirties, forties and even fifties, for instance, become very sick so those cases attract more "medical" attention. Individuals of all ages, however, can develop rheumatic fever.
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