Diagnosing, treating sore throat (primary prevention) should be part of strategy to prevent rheumatic heart disease

September 26, 2013

Diagnosing and treating sore (strep) throat (primary prevention) in children and adolescents to prevent such cases developing into acute rheumatic fever (ARF) and rheumatic heart disease (RHD) should be a cornerstone in any overall RHD strategy. The issues around primary prevention are discussed in one of the papers in the RHD special issue of Global Heart (the Journal of the World Heart Federation) by authors Dr Liesl Zühlke, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa, and Dr Ganesan Karthikeyan, All India Institute of Medical Sciences, New Delhi, India.

Up to one in four cases of sore throat are caused by Group A Streptococcal (GAS) infections that can lead if untreated to ARF/RHD. Simple treatment with oral penicillin or amoxicillin, or injected benzathine penicillin G (BPG-the same treatment used in ) can cure such cases relatively easily and at low cost. Studies have found that treating strep throat with BGP can reduce the risk of subsequent ARF by 70-80%. "Primary prevention is an essential tool for prevention in the absence of a cure for ARF and RHD, and the monumental expense of surgical intervention in patients with these conditions," say the authors.

The obstacles to including primary prevention include the actual diagnosis of (group A strep pharyngitis), treatment options and patient and physician awareness about the possible consequences of an untreated sore throat. For many families in low-income and middle-income countries, a is simply not considered serious enough to warrant a visit to the nearest medical centre, which could be many miles away.

A further issue is the positioning of primary prevention within a control program, and whether introducing widespread screening and treatment in schools is cost-effective. Here, the authors point to the success that was had in Cuba, Costa Rica, Martinique, and Guadeloupe, all of who used a comprehensive strategy involving syndromic treatment of suspected GAS pharyngitis with penicillin which was introduced and maintained for over 10 years. There was also a concerted educational campaign that attempted to involve and target the public, social and educational professions, and media campaigns to raise awareness in each of these locations.

The authors say: "Following on from the excellent work carried out in Cuba, Costa Rica, and other countries, similar programs have now evolved in several other sites, a world-leadingprogram of RHD control in Pacific Island nations has individuals from Tonga, Fiji, and Samoa at the helm, whereas the ASAP (Advocacy, Surveillance, Awareness and Prevention) program, under the auspices of the Pan-African Society of Cardiology has galvanized efforts in Africa to combat this disease."

They add that these efforts have been met with renewed support from global organizations such as the World Heart Federation, which has made a major commitment to leading the charge on RHD control, supporting programs in the Pacific and Africa, establishing an international web-based resource in RF/RHD, and, in their most recent strategic plan, committing to 'eliminating rheumatic fever and minimizing the burden of '.

They conclude: "Rheumatic heart disease is unique among chronic cardiovascular diseases in several ways. It is entirely preventable. It is among the few chronic cardiovascular diseases of childhood, adolescence, and young adulthood, and straddles the silos of infectious and non-communicable diseases and, therefore, represents perfectly the needs of developing countries in the 21st century, now dealing increasingly with this double burden. Primary prevention is the cornerstone of any RHD program and integration into existing primary care systems should be a priority."

Explore further: Screening programs detect cases of undiagnosed rheumatic heart disease in low-resource countries

Related Stories

Screening programs detect cases of undiagnosed rheumatic heart disease in low-resource countries

April 21, 2012
Widespread screening of children in poorer countries is now being studied and is resulting in the diagnosis of rheumatic heart disease (RHD) in patients that would likely have gone undetected under normal circumstances, according ...

Roadmap to 25 percent reduction in premature deaths From RHD in the under 25s by 2025 published

April 8, 2013
The World Heart Federation has published a new position statement outlining the five key strategic targets required to meet its strategic goal for rheumatic heart disease (RHD) – a 25% reduction in premature deaths from ...

Rheumatic heart disease treatment is too late to prevent heart surgery in the Middle East

April 19, 2012
Patients with rheumatic heart disease (RHD) are being admitted to hospital too late to prevent the need for heart surgery, according to a new study carried out by doctors in Yemen and presented today at the World Congress ...

First international guidelines for echocardiographic diagnosis of rheumatic heart disease

February 28, 2012
The inaugural international guidelines for the diagnosis of rheumatic heart disease (RHD), a disease that affects tens of millions of people worldwide, have today been published by the World Heart Federation in Nature Reviews ...

Echocardiogram screenings are effective in preventing rheumatic heart disease

June 12, 2012
Routine screening with echocardiogram can detect three times as many cases of rheumatic heart disease (RHD) as clinical examinations, offering a novel approach in preventing this common disease, according to a new study in ...

New strep throat guidelines tackle antibiotic resistance

September 10, 2012
(HealthDay)—Doctors need to accurately diagnose and treat strep throat in order to avoid inappropriate use of antibiotics that can lead to drug-resistant bacteria, according to updated guidelines from the Infectious Diseases ...

Recommended for you

Early study shows shoe attachment can help stroke patients improve their gait

December 14, 2017
A new device created at the University of South Florida – and including a cross-disciplinary team of experts from USF engineering, physical therapy and neurology – is showing early promise for helping correct the signature ...

Scientists rewrite our understanding of how arteries mend

December 13, 2017
Scientists from The University of Manchester have discovered how the severity of trauma to arterial blood vessels governs how the body repairs itself.

Deadly heart rhythm halted by noninvasive radiation therapy

December 13, 2017
Radiation therapy often is used to treat cancer patients. Now, doctors at Washington University School of Medicine in St. Louis have shown that radiation therapy—aimed directly at the heart—can be used to treat patients ...

Ultra-thin tissue samples could help to understand and treat heart disease

December 12, 2017
A new method for preparing ultra-thin slices of heart tissue in the lab could help scientists to study how cells behave inside a beating heart.

Young diabetics could have seven times higher risk for sudden cardiac death

December 12, 2017
Young diabetics could have seven times more risk of dying from sudden cardiac arrest than their peers who don't have diabetes, according to new research.

Research reveals how diabetes in pregnancy affects baby's heart

December 12, 2017
Researchers at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA have discovered how high glucose levels—whether caused by diabetes or other factors—keep heart cells from maturing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.