Rheumatic heart disease (RHD) is the most common acquired heart disease in children in many countries of the world, especially in developing countries. The global burden of disease caused by rheumatic fever currently falls disproportionately on children living in the developing world, especially where poverty is widespread.

RHD is a chronic heart condition caused by a rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group a streptococcal (strep) infection. Treating strep throat with antibiotics can prevent rheumatic fever. Moreover, regular antibiotics (usually monthly injections) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage.

Consequences of rheumatic heart disease

Acute rheumatic fever primarily affects the heart, joints, and central nervous system. The major importance of acute rheumatic fever is its ability to cause fibrosis of heart valves, leading to crippling valvular heart disease, heart failure, and death.

The decline of rheumatic fever in developed countries is believed to be the result of improved living conditions and availability of antibiotics for treatment of group a streptococcal infection. Overcrowding, poor housing conditions, under nutrition and lack of access to healthcare play a role in the persistence of this disease in developing countries.

Treatment

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.

People who have had a previous attack of rheumatic fever are at high risk for a recurrent attack, which worsens the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever is known as secondary prevention. This involves regular administration of antibiotics, and has to be continued for many years.

Secondary prevention programmes are currently thought to be more cost effective for prevention of RHD than primary prevention and may be the only feasible option for low- to middleincome countries in addition to poverty alleviation efforts.

Surgery is often required to repair or replace heart valves in patients with severely damaged valves, the cost of which is very high and a drain on the limited health resources of poor countries.