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Rheumatic heart disease

Neglected disease of poverty

Rheumatic heart disease affects children and young people living in conditions of poverty, poor sanitation and overcrowding. Practically eliminated in wealthy countries, it is still common in Africa, Asia and the Pacific. Over 15 million people around the world suffer from the condition, which kills hundreds of thousands of people a year and is the most common acquired heart disease found among children and young people in developing countries.

Rheumatic heart disease is often missed in its early stages. It begins with a common throat infection caused by streptococcus bacteria (strep throat), which in some children sets off an abnormal immune reaction that damages heart valves. This reaction, called rheumatic fever, has symptoms that are vague and easily confused with other conditions.

People affected often look and feel healthy again once their outward symptoms are resolved, but with further streptococcal infections the rheumatic fever returns, worsening their heart damage. Often rheumatic heart disease is only detected when it is so advanced that only expensive and complicated heart surgery can save the person's life.

Preventable tragedy

The heart surgery needed at that stage is seldom available or affordable for those who suffer from rheumatic heart disease. If it is, it drains valuable resources from health systems that are still struggling to meet basic health needs. Some countries in the Pacific spend up to 15% of their total health budget sending rheumatic heart disease victims abroad for surgery. Preventing rheumatic heart disease, on the other hand, is safe and cheap: if caught in time, the progression of heart damage can be halted by monthly penicillin injections that prevent streptococcal infection.

The World Heart Federation works with ministries of health, health practitioners and the World Health Organization to enhance rheumatic heart disease control at the national, regional and global levels.  It does this through:

  • Scientific research and exchange on rheumatic heart disease
  • Demonstration projects on rheumatic heart disease control in Africa and the South Pacific
  • Online resources, tools and training materials for rheumatic heart disease control available free of charge for use by health care professionals worldwide

Online Rheumatic Heart Disease Network (RHDnet)

RHDnet is a public health resource developed by the World Heart Federation to support rheumatic heart disease control around the world. The site contains resources for health professionals including best practice tools (sample databases, management guidelines, and staff training resources) as well as links to other programme resources. RHDnet is the first dedicated, global network that attempts to connect and support clinicians and others interested in ARF and RHD control. A members' discussion forum has also been developed to link clinicians and specialists around the world and facilitate communication on various aspects of rheumatic fever and rheumatic heart disease control including secondary prophylaxis, the use of echocardiography and issues around cardiac surgery. A section has also been developed for interested members of the community.

World Heart Federation mission, goals, and targets for control of rheumatic fever (RF) and rheumatic heart disease (RHD):

Mission

  • Minimize the burden of RHD and eliminate RF

Goal

  • Achieve a 25% reduction in premature deaths from RF and RHD among individuals aged <25 years by 2025

Targets

  • Ensure that 90% of countries with endemic RHD have integrated and comprehensive control programmes by 2025
  • Ensure the availability of high-quality benzathine penicillin G for 90% of patients with RHD in 90% of countries with a high burden of this disease within 10 years
  • Foster at least one prominent public figure as an ‘RHD champion’ in every country where RHD is endemic
  • Establish at least one hub of training, research, and advocacy for RF and RHD in each World Health Organization-defined geographic region by 2025
  • Test a group A β haemolytic streptococcal vaccine in phase III clinical trials in RHD-endemic countries within 10 years

Video about Rheumatic Heart Disease in South Africa

Video about Rheumatic Heart Disease in the Pacific

Angola

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Jonathan Lestrade/Courtesy of "Die Burger newspaper"

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