Prevention of Acute Rheumatic Fever and Rheumatic Heart Disease
Acute rheumatic fever (ARF) is primarily the result of a bacterial infection with potentially serious consequences for the heart. ARF develops from contact with a specific bacterium called Group A Streptococcus (GAS).1,2 After exposure, the body generates antibodies to help destroy the bacteria. However, because of close structural similarity between certain parts of the bacterial cell wall and heart tissue, these antibodies may also act against the person’s own heart valves (which separate the different chambers of the heart). This leads to valve damage in the form of narrowed (stenotic) or leaky (regurgitant) valves. Over time, there is progressive damage (rheumatic heart disease, RHD) that may lead to heart failure, stroke, infection of the valves (infective endocarditis), and death.2
This disease has been almost eradicated in Western countries, but remains a major health problem in developing countries and among indigenous populations in wealthy countries. RHD is related to overcrowding, inadequate hygiene, poor access to healthcare, and low awareness. Recent estimates suggest that disability related to RHD alone equals more than a quarter of all cancers put together. Globally, RHD remains the leading cause of heart failure in children and young adults, accounting for at least 250 000 deaths annually.
Natural History of ARF and RHD
ARF usually occurs a few weeks after sore throat caused by GAS and may affect the joints, skin, brain, and heart. Involvement of the heart (occurring in more than half of the cases) results in the most severe manifestations, both acute and long term (Table 1). Although the first ARF episode can sometimes …