Heart Health

Updated 22 April 2013

New action plan against rheumatic heart disease

The World Heart Federation has announced a comprehensive action plan to address rheumatic heart disease, a silent killer that affects mostly poor children in underprivileged areas.

The Heart and Stroke Foundation South Africa has given the thumbs-up to a detailed action plan by the World Heart Federation (WHF) to reduce by 25% the premature deaths from rheumatic fever and rheumatic heart disease in young people under the age of 25 by the year 2025.

“Rheumatic heart disease 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.

She said the Foundation welcomes the goals set by the WHF in view of the fact that rheumatic heart disease is one of the biggest causes of heart failure among children and young people and kills up to 460 000 people across the globe each year.

Streptococcal infection

It is well-known fact that cases of rheumatic fever are underreported. Dr Mungal-Singh says the biggest problem is that rheumatic heart disease occurs in poorer communities in developing countries. It usually starts with an untreated sore throat caused by a streptococcal infection.

Rheumatic fever and heart disease are neglected diseases that require immediate attention,” says Professor Bongani Mayosi from Groote Schuur Hospital and University of Cape Town, South Africa; and Chair of the World Heart Federation Working Group on Rheumatic Fever and Rheumatic Heart Disease.

Dr Mayosi says more data is urgently needed on the disease and cases reported. “Because rheumatic heart disease affects mainly the poor, it is often neglected by researchers, health educators and the media. For example, no accurate, up-to-date statistics are available which can give us an indication of how prevalent the condition is in this country.”

Five key strategic targets

The World Heart Federation’s new strategy has been outlined in a position statement outlining five key strategic targets, which are: comprehensive register-based control programmes, global access to benzathine penicillin G, identification and development of public figures as RHD champions, expansion of RHD training hubs and support for vaccine development.

“This position paper will form the platform for a detailed operational plan to address the barriers to RF and RHD control. The operational plan will be founded on science, research and quantifiable progress indicators to impact positively on millions of individuals with RHD,” says Mayosi.

A number of issues complicate the control of the disease, with access to health care being primary. A simple treatment of antibiotics for strep throat, for example, can prevent rheumatic fever. Regular antibiotic injections can also prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage.

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. If rheumatic fever is left untreated, repeated attacks can cause permanent damage to the heart valves and RHD. About 60% of all acute rheumatic fever cases will develop into RHD.

“Our studies indicate that very few parents and care-givers know of the connection between a sore throat and heart disease in children,” says Dr Mayosi. He advises all children who have sore throats to see a doctor or nurse as soon as possible.

People who have had rheumatic fever before are more susceptible to recurrent bouts. Symptoms include fever, painful or swollen joints, a skin rash, unusual jerky movements and most importantly shortness of breath and exercise intolerance (indicating heart failure).

 - (Heart and Stroke Foundation SA press release)

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