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Vaccine prevention of GAS infections and their immunological complications has been a goal of researchers for decades.

The desire for an effective vaccine arises from the large burden of disease caused by the bacterium, particularly rheumatic fever and rheumatic heart disease.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) occur at very high rates among Aboriginal and Torres Strait Islander people.

We review GAS transmission characteristics and prevention strategies, historical and geographical trends and report on the estimated global burden disease...

Acute rheumatic fever (ARF) is an important cause of heart disease in Indigenous people of northern and central Australia.

In Australia, rheumatic heart disease (RHD) is almost exclusively restricted to Aboriginal Australian and Torres Strait Islander people with children being...

Globally, ARF and RHD cause more than a quarter of a million deaths and substantial disability each year.

Rheumatic heart disease (RHD) is a long-term sequela of acute rheumatic fever (ARF), which classically begins after an untreated or undertreated infection caused by Streptococcus pyogenes (Strep A). RHD develops after the heart valves are permanently damaged due to ARF.

Rheumatic heart disease (RHD) is the most important cause of acquired cardiovascular disease in children and young adults. Virtually non-existent in most of Australia, it still predominantly affects Aboriginal communities.

Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally. Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, revealing a high burden of clinically silent, mild RHD among people who cannot recall a history of preceding acute rheumatic fever. This viewpoint outlines the evidence that this earliest form of rheumatic heart disease, only detectable through echocardiographic screening, is an intermediate stage that many, but not all, individuals may pass through on the pathway to advanced rheumatic heart disease.