Rheumatic heart disease can be treated with penicillin ‘ an inexpensive, safe and common medication, yet many children are still affected by it.
Rheumatic heart disease results from repeated bouts of acute rheumatic fever, which can develop after an untreated sore throat caused by Group A streptococcal (Strep A) infection. Timeous treatment of the Strep A sore throat with antibiotics can prevent rheumatic fever.
Acute rheumatic fever is a notifiable disease by law, which allows the authorities to keep track of cases in the country. However, Dr Mpiko Ntsekhe, a cardiologist at the Department of Medicine, Groote Schuur Hospital in Cape Town, says: ‘Most doctors in South Africa neglect to report cases, leading to the false belief among health officials and other experts that rheumatic heart disease has ‘gone away’. Nothing could be further from the truth. The only excuse for the persistence of rheumatic fever and rheumatic heart disease is neglect on the part of health planners and clinicians.
‘Unfortunately, the link between a sore throat and heart disease is not in the public consciousness and few people seek or get appropriate therapy. Once your child has had rheumatic fever, all is not lost. It is still possible to prevent subsequent serious heart damage by taking penicillin injections or tablets regularly to prevent recurrences of strep throat and rheumatic fever.’
Conditions such as overcrowding, poor housing conditions, under-nutrition and lack of access to healthcare play a role in the persistence of rheumatic heart disease in developing countries. These challenges exist in South Africa, where a large portion of our population lives under poverty-stricken conditions which leave them disproportionately vulnerable to the disease.
‘Strep A attacks the heart valves, brain, joints and skin,’ says Dr Liesl ZÃ¼hlke, Paediatric Cardiologist and Doctoral Fellow of the Mayosi Research Group at the University of Cape Town. ‘Although the other tissues will recover, it is the heart where permanent damage can occur. This permanent damage is known as rheumatic heart disease (RHD). RHD is serious and dramatically affects quality of life, very often requiring open-heart surgery to repair, or replace damaged valves. It can cause heart failure, severe problems during labour and childbirth for pregnant mothers and even death.’
Children are most at risk between the ages of five to 15, and in areas where overcrowding is common. Rheumatic fever is completely preventable by treating the Strep A sore throat with penicillin ‘ primary prevention being an easy and cost-effective remedy. In contrast, treatment of rheumatic heart disease and valve damage is significantly more expensive, requiring surgical intervention.
The cost of surgery to repair or replace heart valves are high, and drain the limited health resources of poor countries. In South Africa, many people have to wait years for surgical treatment, and many more die as a result.
Alarmingly, 60% of all acute rheumatic fever cases will develop into rheumatic heart disease, and estimates suggest that between 62 and 78 million individuals worldwide are affected.
Source: Heart and Stroke Foundation South Africa