Rheumatic Fever and Rheumatic Heart Disease impact millions of lives, especially in vulnerable communities. With timely care and intervention, these life-threatening conditions can be managed.
Rheumatic fever (RF) is caused by an abnormal immune response to infection with a bacteria called Group A Streptococcus (GAS), usually in the throat. Susceptible young people can develop symptoms of RF in the weeks following GAS infection, including joint pain, fevers, skin changes and abnormal movements. During an episode of RF, the heart may also become inflamed, and some children require urgent surgery. The symptoms of RF resolve over a few weeks. However, damage to the heart valve is usually permanent and referred to as rheumatic heart disease (RHD). With repeated episodes of RF, the damaged heart valves become thickened and do not work correctly.
⦿ At least 50 million people live with RHD globally, and 319,000 die annually of the disease.
⦿ Majority of people who live with RHD live in low- and middle-income countries.
⦿ Indigenous and vulnerable communities in high resource settings also experience RHD.
⦿ The majority of deaths resulting from RHD are premature and occur in young adults. Most people who die of RHD are aged under 40 years.
⦿ RF most often affects children between the ages of 5 and 15 years.
⦿ RHD is the most commonly acquired heart disease in young people under the age of 25.
⦿ The recurrence rate of RF is high, particularly in settings where access to health care is limited.
⦿ Without early detection and intervention people with RHD will often become symptomatic in young adulthood.
⦿ Women with RHD are at most significant risk during pregnancy and labour due to the increased pressure on the heart.
Without treatment, life expectancy is significantly reduced by RHD and associated complications. Undetected and untreated RHD can lead to worsening heart valve damage, stroke, heart failure and premature mortality. A significant cause of death and disability from RHD is heart failure. Over time, scarred and damaged heart valves make it impossible for the heart to pump blood effectively. Without a well-functioning heart, fluid builds up in the lungs and body, causing symptoms like breathlessness.
RHD has no cure, but treatment and care options are available, including at the primary health care level.
Clinical management is essential for individuals, and comprehensive control programs are important for populations. Almost exclusively, the people who die of RHD live in low- and middle-income countries or vulnerable communities in high-income countries. Their deaths are preventable with medical knowledge and antibiotics, which have existed for more than half a century. In most high-resource settings, socioeconomic and medical determinants have functionally eradicated RHD.
Yet preventing, diagnosing and treating RF and RHD remains a fitful struggle in low-resource settings. Death and disability from RHD continue to extract an enormous social, economic and cultural toll on young adults and their communities.
The image below describes the different intervention levels. Research, including economic analysis, has shown that primary and secondary prevention, in particular, can be highly effective and efficient investments for countries with known burden of RHD.
Rheumatic Heart Disease is a chronic heart condition, caused by rheumatic fever, that needlessly claims lives and disables individuals living in extreme poverty. The high prevalence of this disease has become a marker of poverty and a significant factor contributing to growing health inequalities. Treating strep throat with antibiotics can prevent rheumatic fever, and regular antibiotic treatment (usually monthly injections) can stop patients with rheumatic fever from developing further strep infections and worsening valve damage. The antibiotic most commonly used, benzathine penicillin G, is off-patent and can be administered through basic primary care for just a few pence.
Urgent action is needed to stop rheumatic heart disease from killing and disabling people among the "bottom billion."
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