Doctors call for countries to step up the fight against rheumatic heart disease

BMJ 2013; 346 doi: (Published 30 May 2013) Cite this as: BMJ 2013;346:f3504
  1. Soumyadeep Bhaumik
  1. 1Kolkata

Greater efforts are needed to prevent rheumatic heart disease (RHD), a meeting at the World Health Assembly was told last week.

Largely eradicated in wealthy countries as a result of effective treatment of its cause, rheumatic fever, RHD remains the commonest acquired heart disease in children in the developing world—“a disease of poverty that kills children, adolescents, and young people in their most productive years,” said K Srinath Reddy, president of the World Heart Federation.

RHD is estimated to cause one death every two minutes, but research interest and funding have diminished since the ending of the Global Programme on rheumatic fever and RHD in 2001.1 Academic publications on the subject have declined by two thirds since the 1970s, and just 0.1% of global health research funding for neglected diseases was targeted at rheumatic fever between 2007 and 2012. Total spending in 2010 was $1.7m (£1.1m; €1.3m), itself a 42% decline compared with the previous year, said Reddy.

The meeting held at the assembly—attended by health officials from countries including New Zealand, South Africa, Australia, Fiji, and Rwanda—was designed to reawaken interest and ensure that control of rheumatic fever and RHD should become an integral part of national health planning.

“RHD control programmes are cost effective,” Reddy said. “Today only a handful of countries, or regions within countries, have adopted these programmes. As member states consider the first global action plan on non-communicable diseases [NCDs], we urge countries where RHD is prevalent to consider integrating plans to tackle this devastating disease into national NCD plans.”

The federation estimates that RHD kills between 233 000 and 468 000 people every year, and that 282 000 new cases are diagnosed each year. In children aged 5-14, prevalence is more than five times higher in sub-Saharan Africa and three times higher in the Pacific and indigenous populations of New Zealand and Australia than in wealthy populations. In the settings where RHD is more prevalent, up to 12.5% of people who develop the disease are at risk of dying each year.

RHD is preventable through low cost interventions delivered by basic health services, such as securing universal access to benzathine penicillin G. Used to treat streptococcal infections in the throat, the antibiotic prevents rheumatic fever and hence RHD.

The World Heart Federation has also called for improved planning and training, and is encouraging the development of a group A β haemolytic streptococcal vaccine. The federation has launched a campaign, 25x25<25, calling for action to reduce RHD mortality by 25% by the year 2025, for individuals younger than 25.

Reddy told the BMJ that improved access to benzathine penicillin G would require establishing a reliable supply, developing international manufacturing guidelines and methods to monitor quality, and developing innovative methods of delivery, such as implants.

In addition, he said, efforts should be made to establish a reliable and affordable supply of World Health Organization listed, essential cardiac medication for tertiary prevention; and to encourage clinical trials and license anticoagulant drugs for valvular disease that do not require therapeutic monitoring.

A position statement on an effective polyvalent vaccine against streptococci by the Decade of Vaccine Collaboration is due for publication in 2013, he added.


Cite this as: BMJ 2013;346:f3504


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