Persisting burden and challenges of rheumaticheart disease

Abstract

Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by anabnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved livingconditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a diseaseof poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease.Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common in-fectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. Thisrelative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years.Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improvingsocial circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent,subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria andappropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immuno-genic determinants of the disease may provide potential routes to vaccine development and other novel therapies.