HEALTH WATCH: When a strep throat can have lifetime effects

By Dr Cory Couillard

HEALTH experts agree that rheumatic heart disease (RHD) has been one of the most neglected of the neglected diseases.

It is often shadowed byinfectious diseases such as HIV/AIDS, malaria and tuberculosis as well as emerging noncommunicable diseases (NCDs) such as coronary heart disease, type 2 diabetes and a variety of cancers.

RHD is also an NCD but it is often overlooked because it is not closely associated with other NCD risk factors such as overweight and obesity, tobacco and alcohol use, physical inactivity and the overonsumption of energy.
Children and young people who suffer from RHD often live in conditions of poverty, poor sanitation, undernutrition and overcrowding. The poorest billion also suffer from low levels of public awareness, shortage of resources, and lack access to essential health care services.
These disparities highlight how NCDs can plague both rich and poor populations in emerging economies. The major difference is that RHD is permanent and is not reversible through lifestyle changes.
A case of rheumatic fever, the cause of RHD, is the leading cause of heart inflammation that often leaves permanent damage to the heart valves. Anyone can get rheumatic fever, but the most common age group is 5 to 15 year olds. Not everyone with rheumatic fever will get RHD but about 60 per cent will develop some degree of subsequent heart disease.
Rheumatic fever is the result of an untreated strep throat that is caused by bacteria called group A streptococcus. The main symptoms of rheumatic fever include fever, muscle aches, swollen and painful joints, and in some cases, a red rash.
Rheumatic fever has the ability to cause fibrosis (scarrnig) of heart valves and lead to crippling valvular heart disease, heart failure and death. RHD is often missed in its early stages and symptoms usually show up 10 to 20 years after the original bout of rheumatic fever.
Recurrent attacks of rheumatic fever can cumulatively damage the heart as well. This damage is often detected in its advanced stages – when expensive and complicated heart surgery is the only option to save a person's life.
Preventing rheumatic fever can prevent the damaging effects of RHD. Doctors can often stop rheumatic fever by treating strep throat with antibiotics.

According to the World Heart Federation (WHF), the “primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by treatment of acute throat infections caused by group A streptococcus. This is achieved by up to 10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection.”
The WHF works with ministries of health, health practitioners and the World Health Organization (WHO) to enhance rheumatic heart disease control at the national, regional and global levels. To date, at least 20 countries, mostly in Africa, have signed on to WHF’s campaign to cut premature deaths caused by RHD by 25 per cent by the year 2025.
RHD may be a disease of the poor but improving public health awareness, ensuring adequate training of health care professionals, and educating schoolteachers of the signs of strep throat can convert knowledge into life-saving action.
Additional information can be found on the World Heart Federation’s website:www.world-heart-federation.org

Dr Couillard is an international health columnist who works in collaboration with the World Health Organization's goals of disease prevention.