Preventing rheumatic heart disease

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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, which is an autoimmune reaction to an untreated streptococcal infection, known as strep throat.

Rheumatic fever occurs somewhere between 2-4 weeks after a strep throat (characterised by a sore throat, pain when swallowing and swollen glands). The symptoms of rheumatic fever include tiredness, joint pain, fever and a rash, often visible on the chest.

The tragedy of this situation is that controlling a strep throat is effective and inexpensive through antibiotics, which prevents the development of rheumatic fever. For those who develop rheumatic fever, regular antibiotic injections can prevent them from contracting further strep infections and causing progressive damage to heart valves.

"RHD is the leading cause of acquired heart disease in children and young adults in South Africa and there is a need to prioritise prevention of the disease and the control of rheumatic fever," says Dr Vash Mungal-Singh, CEO of The Heart and Stroke Foundation South Africa. The decline of rheumatic fever in developed countries is believed to be the result of improved living conditions and availability of antibiotics for treatment. Overcrowding, poor housing conditions, under nutrition and lack of access to healthcare play a role in the persistence of this disease in developing countries.

"RHD is a sentinel condition of poverty and of health inequality; its persistence marks the failure of our health systems to address the non-communicable diseases of the poor. Rheumatic fever and rheumatic heart disease are neglected diseases that require immediate attention," adds Professor Bongani Mayosi from Groote Schuur Hospital, University of Cape Town and chair of the World Heart Federation Working Group on Rheumatic Fever and Rheumatic Heart Disease.

Young children susceptible

Rheumatic fever commonly strikes young children between the ages of five to 15 years. It causes inflammation and damage to several parts of the body, particularly the heart, joints and central nervous system. About 60% of all acute rheumatic fever cases will develop into rheumatic heart disease. Untreated, rheumatic fever can lead to severe heart valve damage. This heart valve damage can result in stroke, congestive heart failure and death. In fact, it is the most common cardiovascular disease in young people under 25 years of age.

Although it is a reaction to a common infectious disease, RHD is a chronic condition that kills or debilitates young people in their most productive years. Treatment of this disease is expensive and complicated, and can even involve the replacement of heart valves. A heart valve replacement can cost around R50,000, placing an enormous burden on the healthcare system. In addition, many South Africans may die whilst awaiting the life-saving operation.

Fortunately, the World Heart Federation has developed a detailed action plan to reduce 25% of the premature deaths from rheumatic fever and RHD in young people under the age of 25 by the year 2025.

RHD 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 hospitalisation 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% of all schoolchildren in Africa, Asia, the Eastern Mediterranean region and Latin America show signs of the disease.
  
• Globally, up to 80 million people suffer from RHD, and up to 460 000 people die from RHD each year, with nearly 300 000 new cases detected every year. However, cases of rheumatic fever are greatly underreported.