1 to 6 August is Rheumatic Fever Week and the Heart and Stroke Foundation South Africa wants to remind all South Africans that a sore throat matters. An age-old disease is still needlessly claiming lives in developing countries amongst poorer communities, including in South Africa. Rheumatic Heart Disease (RHD) is currently receiving global attention with a view to paving the way to beating it once and for all.
A sadly preventable type of heart disease
Rheumatic Heart Disease (RHD) is the most common type of acquired heart disease in children and young people below the age of 25 years. The disease results from an illness called Acute Rheumatic Fever (ARF). In the early 1900s rheumatic fever was one of the most common causes of death, globally, amongst children and young adults. With improved living conditions and the discovery of antibiotics it has all but disappeared in high-income countries.
Rheumatic fever itself is an abnormal immune reaction launched against a common bacterium called Group A Streptococcus. The illness is hallmarked by joint pain, fever above 38°C, feeling generally unwell and tired with shortness of breath, sometimes a skin rash, and uncontrolled body movements. Rheumatic fever is preceded two or three weeks earlier by a bacterial throat infection, commonly called strep throat.
A single episode or repeated episodes of rheumatic fever can cause damage to heart valves. Left untreated RHD snowballs to further heart valve damage, stroke, heart failure, and death. The disease requires life-long medication, medical surveillance and often heart valve replacement surgery. Once someone has contracted rheumatic fever or RHD, it dramatically increases the chance of recurrence.
Sadly, rheumatic fever can be completely prevented by the oldest antibiotic available – penicillin. Professor Liesl Zühlke, a Paediatric Cardiologist and President of the South African Heart Association, further explains, “Effective preventative treatment is both available and cost-effective. It requires that a child with a suspected throat infection is taken to a doctor or clinic, and for a nurse or doctor to correctly diagnose and treat a streptococcal infection”
A disease driven by poverty
RHD affects the poor, the vulnerable, those who are immunocompromised or malnourished. The Group A Streptococcal bacteria spreads easily in densely populated informal areas and where hygiene is poor. Impoverished communities often don’t have easy access to routine medical care or the ongoing medication, follow-up appointments and expensive medical surgery that RHD requires.
Worldwide the disease claims 275 000 lives annually and affects 33 million people, mostly in developing countries and impoverished communities. According to the global movement RHD Action there were 42 600 cases of RHD in South Africa in 2013, a 55% increase since 1990. Three times more girls and women are affected compared to males. RHD further places pregnant women at great risk during labour and delivery.
On the South African and global agenda
Several South African experts have worked tirelessly as part of ongoing international efforts to increase global commitment to eradicate RHD. In June 2017, the #TimeToTackleRHD campaign finally bore fruit. The World Health Organization recommended a resolution on Rheumatic Fever and RHD to be adopted at the 2018 World Health Assembly. This will make RHD a global health priority on the world stage. National decision-makers will need to take action to prioritise and fund RHD prevention and control.
Global efforts to fight RHD were further strengthened in July 2017 when the American Heart Association announced a $3.7 million grant towards improving the prevention and diagnosis of the disease. Multinational efforts will focus on three topics; investigating strains of streptococcal bacteria, understanding and detecting rheumatic fever, and improving cost-effective service delivery.
Cape Town has been selected as the location for investigating different strains of streptococcal bacteria. Researchers will capture and classify local strains of the streptococcal bacteria. Understating the bacteria and the immune response that it triggers could pave the way to vaccine development.
The World Heart Federation goal: 25×25<25
The World Heart Federation’s goal is Achieve a 25% reduction in premature deaths from rheumatic fever and RHD among individuals aged under 25 years by 2025. To achieve this requires multi stakeholder engagement to prevent streptococcal throat infections, diagnose and treat rheumatic fever, and diagnose and provide ongoing medical care for rheumatic heart disease. Larger problems such as overcrowding, poor hygiene, and improved medical surveillance will also need to be addressed.
“Poor living conditions and poverty are established drivers of poor health and disease onset. RHD is no exception” says Prof Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa. Prof Naidoo continues to emphasize that “whilst the issue of the relationship between social conditions and health are complex, it is imperative that policy makers and health advocates influence change at a social and economic level to improve health outcomes for children and young adults in South Africa, regionally, and globally”.
What can communities do?
School teachers and other caregivers can make a difference by simply looking out for a sore throat and by educating parents and children about the ill-effects of a sore throat if left untreated. A sore throat in the absence of a cold or flu could possibly be a strep throat, which can cause rheumatic fever. A child should be taken to the doctor or clinic if a strep throat is suspected.
Sore throats matter!
Strep throat usually presents with throat pain or pain on swallowing, fever higher than 38°C and feeling unwell with a headache, nausea, vomiting or weakness. Inside the throat, the tonsils may be red, swollen or have white pus on them. With the following three actions, everyone can help to reduce strep throat infections:
- Seek medical advice for a sore throat
- A child with strep throat should stay away from school to avoid spreading the infection to other children.
- Teach children good hygiene to prevent the spread of germs