Rheumatic heart disease (RHD) is the most common acquired heart
disease in children in many countries of the world, especially in developing
countries. The global burden of disease caused by rheumatic fever currently
falls disproportionately on children living in the developing world, especially
where poverty is widespread.
RHD is a chronic heart condition caused by rheumatic fever that
can be prevented and controlled. Rheumatic fever is caused by a preceding group
A streptococcal (strep) infection. Treating strep throat with antibiotics can
prevent rheumatic fever. Moreover, regular antibiotics (usually monthly
injections) can prevent patients with rheumatic fever from contracting further
strep infections and causing progression of valve damage.
Consequences of rheumatic heart disease
Acute rheumatic fever primarily affects the heart, joints and
central nervous system. The major importance of acute rheumatic fever is its
ability to cause fibrosis of heart valves, leading to crippling valvular heart
disease, heart failure and death.
The decline of rheumatic fever in developed countries is
believed to be the result of improved living conditions and availability of
antibiotics for treatment of group A streptococcal infection. Overcrowding,
poor housing conditions, undernutrition and lack of access to healthcare play a
role in the persistence of this disease in developing countries.
Rheumatic heart disease facts
The global burden of disease caused by rheumatic fever and RHD
currently falls disproportionately on children and young adults living in
low-income countries and is responsible for about 233,000 deaths annually.
At least 15.6 million people are estimated to be currently
affected by RHD with a significant number of them requiring repeated
hospitalization and, often unaffordable, heart surgery in the next five to 20
years.
The worst affected areas are sub-Saharan Africa, south-central
Asia, the Pacific and indigenous populations of Australia and New Zealand.
Up to 1 per cent of all schoolchildren in Africa, Asia, the
Eastern Mediterranean region, and Latin America show signs of the disease.
Treatment
Primary prevention of acute rheumatic fever (the prevention of
initial attack) is achieved by treatment of acute throat infections caused by
group A streptococcus. This is achieved by up to 10 days of an oral antibiotic
(usually penicillin) or a single intramuscular penicillin injection.
People who have had a previous attack of rheumatic fever are at
high risk for a recurrent attack, which worsens the damage to the heart.
Prevention of recurrent attacks of acute rheumatic fever is known as secondary
prevention. This involves regular administration of antibiotics, and has to be
continued for many years. Secondary prevention programmes are currently thought
to be more cost effective for prevention of RHD than primary prevention and may
be the only feasible option for low- to middle-income countries in addition to
poverty alleviation efforts.
Surgery is often required to repair or replace heart valves in
patients with severely damaged valves, the cost of which is very high and a drain
on the limited health resources of poor countries.
