Materiały źródłowe

• #1 The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3046187/

  Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. […] It is estimated that there are over 15 million cases of RHD worldwide, with 282,000 new cases and 233,000 deaths annually. […] More recent data using echocardiography to screen for RHD in developing nations have lead to a marked increase in the recognized prevalence in these regions. […] The last major WHO report on the worldwide prevalence of ARF and RHD reported data through 1990. […] The reported incidence of ARF is decreasing in all WHO Regions except for the Americas where it appears to be increasing slightly and the Western Pacific, where it appears to be steadily increasing. The reported prevalence of RHD is increasing in all regions except for Europe, where it appears to be decreasing.

• #2 The worldwide epidemiology of acute rheumatic fever and rheumatic hear | CLEP

  https://www.dovepress.com/the-worldwide-epidemiology-of-acute-rheumatic-fever-and-rheumatic-hear-peer-reviewed-fulltext-article-CLEP

  Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. […] Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. […] This review provides background on the history of ARF, its pathology and treatment, and the current reported worldwide incidence of ARF and prevalence of RHD.

• #3 Acute rheumatic fever: Epidemiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/acute-rheumatic-fever-epidemiology-and-pathogenesis/print

  Acute rheumatic fever (ARF) is one of the nonsuppurative complications (others include scarlet fever and acute glomerulonephritis [AGN]). […] The epidemiology and pathogenesis of ARF are reviewed here. […] In low-resource areas of the world, severe disease caused by group A Streptococcus (GAS; eg, ARF, rheumatic heart disease, glomerulonephritis, and invasive infections) is estimated to affect over 33 million people, and rheumatic heart disease is the leading cause of cardiovascular death during the first five decades of life. […] ARF can occur at any age, although most cases occur in children 5 to 15 years of age. […] Worldwide, based upon conservative estimates, there are approximately 470,000 new cases of ARF and 320,000 deaths attributable to rheumatic heart disease each year. […] Most cases occur in low- and middle-income countries and among indigenous populations, with risk factors including overcrowding and limited access to health care.

• #4

  https://link.springer.com/article/10.1007/s11936-017-0513-y

  Acute rheumatic fever (ARF) and its sequel, rheumatic heart disease (RHD), cause significant morbidity and mortality in developing countries, yet they are under-recognized as global health problems. […] A recent surge in the scientific exploration of ARF and RHD has resulted in alternate hypotheses regarding the pathogenesis of ARF, new global burden of disease estimates and revised diagnostic criteria. […] The most recent estimates of the global burden of RHD include 9 million disability-adjusted life years lost, 33 million prevalent cases and 275,000 deaths each year, with deaths occurring predominantly in low- and middle-income countries (LMICs). […] The epidemiology of RHD varies by region, with a particularly high prevalence in Africa and the Pacific region but a high burden also in Latin America, the Middle East and Asia.

• #5 Acute rheumatic fever: Epidemiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/acute-rheumatic-fever-epidemiology-and-pathogenesis/print

  The mean incidence of ARF is 19 per 100,000 school-aged children worldwide, but it is lower (≤2 cases per 100,000 school-aged children) in the United States and other high-resource countries, having declined since the middle of last century. […] In many low- and middle-income countries and in certain Indigenous populations, such as those in Australia and New Zealand, the incidence of ARF is substantially higher, with some of the highest rates reported in Indigenous Australians at 153 to 380 cases per 100,000 children aged 5 to 14 years.

• #6 Acute Rheumatic Fever: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/333103-overview

  Worldwide, as many as 20 million new cases of ARF occur each year, predominantly in developing countries. The introduction of antibiotics has been associated with a rapid worldwide decline in the incidence of ARF. Currently, the incidence is 0.23-1.88 patients per 100,000 population. From 1862-1962, the incidence per 100,000 population declined from 250 patients to 100 patients, primarily in teenagers. […] Most major outbreaks occur under conditions of impoverished overcrowding where access to antibiotics is limited. Rheumatic heart disease accounts for 25-50% of all cardiac admissions internationally. Rates of rheumatic heart disease and related deaths are particularly high in Oceania, South Asia, and central sub-Saharan Africa. […] Rates of ARF are exceptionally high in natives of Polynesian ancestry in Hawaiian and Maori populations. For example, in a study from a New Zealand district, the ethnicity of ARF patients was 85% Maori and 10% Pacific. Although the annual incidence of ARF was 3.1 per 100,000 population overall, in Maori children aged 5-14 years the incidence was 46.1 per 100,000 population. Almost three-quarters of all patients lived in severely socioeconomically deprived areas.

• #7 Acute Rheumatic Fever: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/333103-overview

  In Australia, the age-standardized first-ever rates of ARF were 71.9 per 100,000 population for indigenous populations, compared with 0.60 per 100,000 for non-indigenous populations. […] In the past decade, an increase in the incidence of ARF was observed in Slovenia, in south-central Europe. From 2008 through 2014, the estimated annual incidence of ARF was 1.25 cases per 100,000 children. […] A study of pediatric patients (age 0-17 years) in Lombardy, Italy who were hospitalized with the diagnosis of ARF from 2014 to 2016 found that the annual hospitalization rate was 4.24 cases per 100,000 children. A seasonal trend was evident, with fewer cases in the autumn and a peak in the spring. […] The initial attack of ARF occurs most frequently in persons aged 5-15 years. It is relatively rare in infants and uncommon in preschool-aged children. ARF occurs in young adults, but the incidence of first episodes of ARF falls steadily after adolescence and is rare after age 35 years. The lower rate of ARF in adults may represent a decreased risk of streptococcal infections in this cohort. Recurrent episodes, with their predisposition to cause or exacerbate valvular damage, occur until middle age. In some countries, a shift into older groups may be a trend.

• #8 Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005–2007 | The Medical Journal of Australia

  https://www.mja.com.au/journal/2009/190/3/acute-rheumatic-fever-and-rheumatic-heart-disease-fiji-prospective-surveillance

  The average annualised incidence of definite cases of ARF in children aged 5-15 years was 15.2 per 100,000 (95% CI, 9.0-22.6). […] Rates of acute rheumatic fever (ARF) have remained stable in many developing countries, despite a dramatic decline in the incidence of ARF in industrialised countries in the 20th century. […] Globally, it is estimated that more than 330,000 cases of ARF occur each year in children aged 5-14 years and that over 95% of these cases are found in less developed countries. […] The incidence of ARF in 5-15 year-olds in our study is comparable to rates in various outbreaks described in the US in the 1980s. […] Comparison of our data for ARF incidence in children aged 5-15 years (15.2 per 100,000) with figures from previous reports from Fiji indicates that the incidence of ARF may be declining.

• #9 An epidemiological survey of rheumatic fever and rheumatic heart disease in Sahafa Town, Sudan. | Journal of Epidemiology & Community Health

  https://jech.bmj.com/content/46/5/477

  STUDY OBJECTIVE–The aim was to determine the prevalence of rheumatic fever and rheumatic heart disease and to initiate a programme of secondary prophylaxis in Sahafa Town, Sudan. […] MAIN RESULTS–Out of the 13,322 children screened 351 were suspected cases and 146 were confirmed cases of rheumatic fever or rheumatic heart disease. The prevalence rates for all ages were 10/1000 for boys and 14/1000 for girls. The overall prevalence rate of the whole programme area was 11/1000, prevalence of rheumatic fever was 8/1000, and prevalence of rheumatic heart disease was 3/1000. The prevalence rate was significantly increased among the inner town inhabitants (15/1000) compared to the outer town inhabitants 4/1000 (p 0.001). […] CONCLUSIONS–Rheumatic fever continues to be a serious health problem. With economic pressures causing impending change in socioeconomic conditions in most Third World countries in the immediate future, rheumatic fever will continue to have a high prevalence rate and rheumatic fever and rheumatic heart disease prevention programmes will remain a central goal.

• #10

  https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease

  Rheumatic fever mostly affects children and adolescents in low- and middle-income countries and in marginalized communities, including Indigenous populations, especially where poverty is widespread and access to health services is limited. […] Despite it being eradicated in many parts of the world, the disease remains prevalent in sub-Saharan Africa, the Middle East, central and south Asia, the south Pacific, and among immigrants and older adults in high-income countries, especially Indigenous peoples. […] For countries where rheumatic heart disease is endemic, the main strategies for prevention, control and elimination include improving standards of living; expanding access to screening and appropriate care for people with suspected or confirmed streptococcal infections and RF/RHD and treatment of RHD complications with medications; ensuring a consistent supply of quality-assured antibiotics for primary and secondary prevention; and planning, developing and implementing feasible programmes for prevention and control of rheumatic heart disease, supported by adequate monitoring and surveillance, as an integrated component of national health systems responses.

• #11 Rheumatic fever – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588

  Rheumatic fever is rare in the United States and other developed countries. […] Things that may increase the risk of rheumatic fever include: […] Overcrowding, poor sanitation and other conditions can cause strep bacteria to easily spread among many people. These conditions increase the risk of rheumatic fever. […] The best way to prevent rheumatic fever is to treat strep throat infections or scarlet fever right away.

• #12 Rheumatic fever | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/rheumatic-fever-1?lang=us

  Rheumatic fever is an illness caused by an immunological reaction following group A streptococcal infection. […] Risk factors include: children and adolescents aged 5 to 15 years, developing nations where antibiotic prescription is low, poverty, overcrowding. […] Not all group A streptococcal bacteria are capable of producing rheumatic fever, likewise not all patients with a group A streptococcus infection develop rheumatic fever, so therefore there are underlying patient susceptibility and bacterial factors that determine if rheumatic fever will occur. […] Repetitive episodes of rheumatic fever increases the risk of developing rheumatic heart disease, with 60% of patients eventually doing so.

• #13 Rheumatic fever epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Rheumatic_fever_epidemiology_and_demographics

  The incidence of rheumatic fever among developed nations is low, likely due to improved hygienic standards and routine use of antibiotics for acute pharyngitis. […] The rates of rheumatic fever and rheumatic heart diseases among developing nations have mixed trends. Recently, the incidence rate of rheumatic fever has decreased in India, China, and African countries, which has been mainly attributed to improved access to medical treatment. […] It is estimated that approximately there are 62-78 million rheumatic heart disease patients worldwide, which could potentially result in 1.4 million deaths per year. […] Occurrence of rheumatic fever is associated with low socioeconomic and over crowded conditions.

• #14 Rheumatic Fever | Utah Epidemiology

  https://epi.utah.gov/rheumatic-fever/

  Most cases of rheumatic fever occur in people who have untreated strep (sore throat) infections. Rheumatic fever can cause permanent damage to the heart, with abdominal pain, joint pain, joint swelling, and skin rash also following. It occurs mostly among children 5–15 years old and approximately 14–28 days after strep throat.

• #15 Preventing Rheumatic Heart Disease

  https://www.uspharmacist.com/article/preventing-rheumatic-heart-disease

  Rheumatic heart disease (RHD) is a major problem in developing countries and is the cause of most of the cardiovascular mortality in young people. In 2015, there were approximately 320,000 deaths from RHD and 33 million individuals living with RHD. In sub-Saharan Africa, South Asia, and Oceania, the overall prevalence of RHD was estimated at 10 to 15 cases per 1,000. The African, South-East Asian, and Western Pacific regions are the worst affected, accounting for 84% of all prevalent cases and 80% of all estimated deaths due to RHD in 2015. Rheumatic heart disease disproportionately affects girls and women. The risk of RHD is 1.6 to 2.0 times greater in women, likely due to several factors, including worsening of existing disease during pregnancy, GAS exposure during child rearing, limited access to services, and intrinsic/hormonal factors. Socioeconomic and environmental factors such as overcrowding, poor housing conditions, undernutrition, and lack of access to healthcare play a role in the persistence of this disease in developing countries.

• #16 Some Aspects of Epidemiology and Surveillance of Rheumatic Fever · 研飞ivySCI

  https://www.ivysci.com/en/articles/4086481__Some_Aspects_of_Epidemiology_and_Surveillance_of_Rheumatic_Fever

  Some Aspects of Epidemiology and Surveillance of Rheumatic Fever […] The aim of the study was to find the most reliable and precise incidence of rheumatic fever attacks in the general population. […] Epidemiological studies are one of the most important components of the surveillance of rheumatic fever.

• #17 Some Aspects of Epidemiology and Surveillance of Rheumatic Fever · 研飞ivySCI

  https://ivysci.com/articles/4086481__Some_Aspects_of_Epidemiology_and_Surveillance_of_Rheumatic_Fever

  Some Aspects of Epidemiology and Surveillance of Rheumatic Fever […] The aim of the study was to find the most reliable and precise incidence of rheumatic fever attacks in the general population. […] Epidemiological studies are one of the most important components of the surveillance of rheumatic fever. […] Further important tasks are early diagnosis and hospitalization, introduction of adequate therapy and (effective) prophylactic measures, with periodic checkups.

• #18 Rheumatic Fever 1997 Case Definition | CDC

  https://ndc.services.cdc.gov/case-definitions/rheumatic-fever-1997/

  Rheumatic fever is a surveillance case definition that is a set of uniform criteria used to define a disease for public health surveillance. Surveillance case definitions enable public health officials to classify and count cases consistently across reporting jurisdictions. […] The 1997 case definition appearing on this page was previously published in the 1990 MMWR Recommendations and Reports titled Case Definitions for Public Health Surveillance. Thus, the 1990 and 1997 versions of the case definition are identical.

• #19

  https://www.who.int/news-room/fact-sheets/detail/rheumatic-heart-disease

  Currently a large proportion of those suffering rheumatic heart disease are not diagnosed or are diagnosed at a late stage when damage to the heart is very severe. […] In 2018, the World Health Assembly adopted resolution WHA 71.14 calling for WHO to launch a coordinated global response to rheumatic heart disease and rheumatic fever.

• #20 Standardization of Epidemiological Surveillance of Acute Rheumatic Fever – PubMed

  https://pubmed.ncbi.nlm.nih.gov/36128408/

  Acute rheumatic fever (ARF) is a multiorgan inflammatory disorder that results from the body’s autoimmune response to pharyngitis or a skin infection caused by Streptococcus pyogenes (Strep A). Acute rheumatic fever mainly affects those in low- and middle-income nations, as well as in indigenous populations in wealthy nations, where initial Strep A infections may go undetected. […] We outline the considerations specific to ARF surveillance methodology, including discussion on where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare, administrative database review), participant eligibility, and the surveillance population. Additional considerations for ARF surveillance, including implications for secondary prophylaxis and follow-up, ARF registers, community engagement, and the impact of surveillance, are addressed. […] Finally, the core elements of case report forms for ARF, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.

• #21 Improving rheumatic fever surveillance in New Zealand: results of a surveillance sector review | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-528

  The New Zealand (NZ) Government has made a strong commitment to reduce the incidence of rheumatic fever (RF) by two thirds, to 1.4 cases per 100,000, by mid-2017. […] However, it is actually unclear what the true rate of RF is, or how current interventions are altering it, due to major flaws affecting every RF surveillance system operating on a national scale. […] Public health surveillance is vital for supporting infectious disease prevention and control measures. […] In NZ there are three major systems used to monitor RF: national hospitalisation data, national notification data (based on notifications to Medical Officers of Health) and regional patient registers. […] Extensive under-reporting has been well documented in RF notification data and register data. […] A surveillance sector review framework was devised in 2010 as a means for supporting countries to meet this assessment goal.

• #22 Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-022-02699-2

  Prevention and surveillance activities, i.e., outpatient register, comprehensive prevention programme, and cardiac surgery, have been established since 2010 along with the Global Rheumatic Heart Disease Registry (REMEDY), a two-year longitudinal study across 14 countries from 2010 to 2012. […] Limited cardiac expertise, weak surveillance systems, and lack of diagnostic equipment remain a challenge for the RHD prevention and control interventions in LMICs. […] A gap was identified in data and official reports of the burden of RHD in Namibia, causing uncertainty on the sources of information supporting the GBD report. […] The study aimed to estimate the prevalence of RHD from the outpatient and inpatient registers between 2010 and 2020 and describe RHD-related healthcare practices in Namibia.

• #23 Acute rheumatic fever in the UK and Ireland: a BPSU surveillance study | Archives of Disease in Childhood

  https://adc.bmj.com/content/early/2025/01/19/archdischild-2024-328277

  Higher rates of childhood Streptococcus pyogenes (group A Streptococcus (GAS)) infections following the COVID-19 pandemic have exposed uncertainty about the epidemiology of immune-mediated complications of GAS in high-income settings. […] Acute rheumatic fever (ARF) is of primary concern due to its potential to cause life-threatening carditis. Early recognition of ARF is critical to prevent progression to rheumatic heart disease, a significant cause of premature death globally. […] Accordingly, we reanalysed data from a hitherto unpublished British Paediatric Surveillance Unit (BPSU) ARF study run from May 2015 to May 2016. Briefly, UK and Republic of Ireland (RoI) consultant paediatricians were asked to provide monthly reports and details of Any cases of children or young people 016 years of age with either a confirmed or suspected new diagnosis of ARF seen in the past month. Subsequently, we categorised reported cases into confirmed ARF using the Jones Criteria for low-risk populations.

• #24 Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-022-02699-2

  Of the total population, we estimated an RHD prevalence of 0.032% from the outpatient register, while the cumulative incidence of RHD was 0.058% in the inpatient register, respectively. […] An important piece in understanding the burden of RHD and the true prevalence of RHD in Namibia is the undiagnosed cases. […] Our interpretation is that the GBD study has included a prediction of the RHD prevalence in Namibia based on both diagnosed and undiagnosed cases. […] To understand the true burden of disease in Namibia, population-based screening studies are needed. […] The occurrence of RHD is common in the northern regions dominated by rural areas with limited socioeconomic resources. […] A declining pattern was found in the yearly number of registered RHD cases in the outpatient register, but the cause of the pattern is unclear.

• #25 Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-022-02699-2

  Frail surveillance systems persist to challenge the understanding of the true burden of disease in LMICs. […] Future recommendations are outlined below to inform planning and changes in Namibia and similar settings. […] This will be valuable to introduce ARF and RHD surveillance forms at primary healthcare facilities as part of the current routine health information systems. […] Patient unique identifiers must be introduced in the surveillance systems to strengthen data quality and allow for monitoring of patients across different levels of care. […] The commitment to the treatment and management of RHD e.g., cardiac surgery in Namibia is commendable. However, it will be valuable to prioritise efforts at the primordial and primary prevention levels. […] Routine care at the primary and secondary healthcare levels must include laboratory testing for group A streptococcal (GAS) bacteria among people with pharyngitis, especially children.

• #26 Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-022-02699-2

  Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. […] The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia. […] The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. […] We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities. […] The prevalence of RHD is expected to be lower than previously reported. […] Surveillance systems needs improvements to enhance data quality.

• #27 Estimating the likely true changes in rheumatic fever incidence using two data sources | Epidemiology & Infection | Cambridge Core

  https://www.cambridge.org/core/journals/epidemiology-and-infection/article/estimating-the-likely-true-changes-in-rheumatic-fever-incidence-using-two-data-sources/997AC920A90FA407F2AE7F9CDE2D74F5

  NZ has two national sources of ARF surveillance data, hospitalisations and notifications, but major limitations affect both. Consequently, accurate case totals cannot be generated. Hospitalisation data come from the National Minimum Dataset (NMDS), which contains information on all publicly funded hospitalisations. As ARF is a serious condition, it is recommended suspected cases be hospitalised. Thus, in theory, ARF hospitalisation data should be fairly complete. However, overcounting has been observed; an audit of hospitalisation data from the Waikato district health board (DHB) area found cases were over-counted by 25%. An audit of Auckland regional data identified an even higher level of over-counting, at 33%. ARF has been notifiable to public health authorities since 1986. Case notification data are compiled on the EpiSurv database. In our previous research paper, we used these two data sources to estimate the likely true number of ARF cases arising over the period 1997-2011. Our study noted significant under-notification to the EpiSurv national case database, although the discrepancy between these two data sources reduced in recent years. At worst, regional under-notification approached 50%.

• #28 Improving rheumatic fever surveillance in New Zealand: results of a surveillance sector review | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-528

  The most frequently identified surveillance sectors gaps concerned leadership and coordination, information integration, analysis and communication. […] A comprehensive RF surveillance strategy should be developed in order to communicate and coordinate these improvements. […] There is a clear need for a well-run online national RF register. […] The RF notification dataset is effectively operating as a national register already. […] The main additional functional requirements are for greater case management utility, revision of data fields and associated documentation, and processes to ensure effective clinical engagement. […] The surveillance sector review approach facilitated a thorough review of the RF surveillance sector.

• #29 Improving rheumatic fever surveillance in New Zealand: results of a surveillance sector review | BMC Public Health | Full Text

  https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-14-528

  We have successfully used this novel framework to perform a surveillance sector review with the aim of identifying potential improvements which would support optimal RF control and prevention activities. […] The RF surveillance sector has a strong emphasis on control-focussed surveillance. […] These support delivery of antibiotic prophylaxis to identified RF cases. […] All KIs felt that up-to-date, reasonably detailed epidemiological information should be available at a national and regional scale with accompanying information, such as throat swabbing program coverage information, to put it into context. […] The key strategy-focused surveillance gap was the inability to generate consistent national and regional case totals. […] Many KIs pointed out that checking case notes before notifying may improve the accuracy of notification data.

• #30 Preventing Rheumatic Heart Disease

  https://www.uspharmacist.com/article/preventing-rheumatic-heart-disease

  The World Health Organization defines secondary prophylaxis as the continuous administration of specific antibiotics to patients with a previous attack of rheumatic fever, or well-documented rheumatic heart disease. The purpose is to prevent colonization or infection of the upper respiratory tract with group A beta-hemolytic streptococci and the development of recurrent attacks of rheumatic fever. The minimum duration of secondary prophylaxis in most guidelines is 10 years. In severe cases, lifelong regular benzathine penicillin G administration may be recommended. […] RHD is one of the most common and preventable acquired heart diseases, with valvular heart damage as the hallmark. Although the number of cases in developed countries has been reduced drastically, the same cannot be said of developing countries. There are multiple opportunities to intervene along the strep A to RHD pathway and prevent morbidity and mortality.

• #31 The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3046187/

  The literature review revealed data on the incidence and/or prevalence of ARF and RHD in 100 countries around the world. […] The prevalence of RHD appears to be increasing worldwide. Given that the incidence of ARF has been decreasing in most regions, it is not likely due to increases in the disease. Major advances in medical and surgical treatments for RHD have led to increased survival, which has contributed to an increased prevalence of RHD. […] Implementing systematic surveillance and treatment of GABHS pharyngitis, particularly through school-based programs, is crucial to the control and prevention of ARF.

• #32 Rheumatic fever – Wikipedia

  https://en.wikipedia.org/wiki/Rheumatic_fever

  In countries in Southeast-Asia, sub-Saharan Africa, and Oceania, the percentage of people with rheumatic heart disease detected by listening to the heart was 2.9 per 1000 children and by echocardiography it was 12.9 per 1000 children. […] To assist in the identification of RHD in low resource settings and where prevalence of GAS infections is high, the World Heart Federation has developed criteria for RHD diagnosis using echocardiography, supported by clinical history if available. […] Echocardiographic screening among children and timely initiation of secondary antibiotic prophylaxis in children with evidence of early stages of rheumatic heart disease may be effective to reduce the burden of rheumatic heart disease in endemic regions.

• #33 Rheumatic fever Identification, management and secondary prevention

  https://www.racgp.org.au/afp/2012/january-february/rheumatic-fever

  Acute rheumatic fever predominantly affects Aboriginal and Torres Strait Islander children aged 514 years living in regional and remote areas of central and north Australia. It has an estimated incidence of 250350 per 100 000.2 However, little is known about the epidemiology of ARF and RHD in southern regions of Australia, despite the fact that an estimated 57% of the Aboriginal and Torres Strait Islander population live in these regions.3,4 […] General practitioners are integral to ensuring early diagnosis and early treatment of ARF to minimise heart valve damage and progression to RHD. […] Early detection of ARF and implementation of appropriate secondary prophylaxis regimens are essential to lower the rates of recurrent ARF and subsequent development of RHD. […] Coordinated RHD control programs may be an efficient and effective way to improve benzathine penicillin G adherence and clinical care for the long term prevention of RHD.

• #34 Trends in Deaths from Rheumatic Heart Disease in the Eastern Mediterranean Region: Burden and Challenges

  https://www.mdpi.com/2308-3425/5/2/32

  Rheumatic heart disease (RHD) is a preventable disease that is prevalent in developing regions of the world. Its eradication from most developed countries indicates that this disease can be controlled and eliminated. […] The World Health Organization was the first to release guidelines for the prevention and control of streptococcal disease and Rheumatic fever (RF) that have since been updated and adapted by many countries and regions around the world. […] A recent analysis from the Global Burden of Disease 2015 study for the EMR region has shown that age-standardized death rates (per 100,000) (ASDR) from RHD have decreased from 9.1 in 1990s to 6.8 in 2015 (a 25% reduction), although the number of cases overall has increased from 18,350 to 27,047 (a 47% increase). […] The challenge of controlling and eradicating RHD is great, and although the disease has declined over past decades, recent data still indicate that the burden of streptococcal disease remains unchanged.

• #35

  https://journals.lww.com/nijc/fulltext/2020/17010/rheumatic_heart_disease_in_nigeria__a_review.4.aspx

  The lesson from high-income countries and some developing countries is that the disease can be controlled through comprehensive, register-based RHD control programs. […] The best explanation is that intense host reactions and recurrent RF were the major determinants of accelerated MS. […] The common symptoms at presentation include cough (87.9%), easy fatigability (50.5), dyspnea on exertion (100%), orthopnea (100%), and paroxysmal nocturnal dyspnea (74.8%). […] The spectrum of complications in various adult studies in the country is also shown in Table 6. Congestive cardiac failure is by far the most common complication. This is the mode of presentation in over 80% of cases in Abeokuta. […] RHD is mainly a disease that begins in childhood. It has its peak incidence in children aged 5-15 years and young adults below the age of 30 years.

• #36 Acute Rheumatic Fever: Diagnosis and Initial Management

  https://www.ebmedicine.net/topics/infectious-disease/pediatric-rheumatic

  Acute rheumatic fever is an inflammatory reaction involving the joints, heart, and nervous system that occurs after a group A streptococcal infection. […] Despite the low prevalence in the United States, the global burden of ARF and rheumatic heart disease remains high. It is estimated that there are 471,000 new cases of ARF each year, with the overall burden of rheumatic heart disease estimated at 15.6 million cases and over 233,000 deaths per year worldwide. […] The existing literature will be examined and an understanding of the clinical features of ARF and an evidence-based framework to approach the diagnosis and management of ARF will be provided. […] A search through the National Guideline Clearinghouse database revealed an Australian guideline for prevention, diagnosis, and management of ARF and rheumatic heart disease from Rheumatic Heart Disease Australia, Menzies School of Health Research, National Heart Foundation of Australia, and the Cardiac Society of Australia and New Zealand. […] Because ARF rates remain very high in aboriginal communities in Australia, it seems prudent to include the Australian Pediatric Society recommendations in this evidence-based report. […] The global burden of group A streptococcal diseases.

• #37 Trends in Deaths from Rheumatic Heart Disease in the Eastern Mediterranean Region: Burden and Challenges

  https://www.mdpi.com/2308-3425/5/2/32

  The total deaths for the region peaked twice: in early adulthood and again later in old age, and was higher in females than in males. […] The highest total deaths were reported from Egypt, Pakistan, Iran, Afghanistan, and Yemen, representing 80% of the total death rates for the region (35,248). […] The ASDR for RHD was highest in low income countries. […] The findings of differential data between WHO global data banks, other data banks, and national reporting, indicate that the burden of the disease may continue to represent a challenge. […] The challenges related to controlling RHD are related to under detection, under reporting, poor compliance, poor access to care, poor prognosis, poor postoperative care, poor registration systems, and lack of equitable access to gold standard screening methods. […] The World Health Assembly resolution for RF and RHD on its 71st meeting is expected to bring hope for renewed efforts to control and eliminate Rheumatic fever and Rheumatic heart disease globally.

• #38 Acute rheumatic fever and rheumatic heart disease | Nature Reviews Disease Primers

  https://www.nature.com/articles/nrdp201584

  Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. […] The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. […] Recent advances including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.

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