Rheumatic Fever Week 2021

02 Aug 2021
02 Aug 2021

South Africa will be recognising Rheumatic Fever Week from 2 through 8 August this year with the intention of raising awareness about Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) throughout the country. The South African Department of Health declared the first week of August Rheumatic Fever Week over twenty- five years ago. This recognition brought long overdue recognition to this preventable condition that disproportionately impacts women and children in low and middle-income countries, on the African and Asian continents, the Middle East and the Pacific.

What is Rheumatic Fever and 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 RF. 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 against a common bacterium called Group A Streptococcus. Patients typically experience a range of symptoms that can include 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. Strep throat usually presents with throat pain or pain on swallowing, fever higher than 38°C and feeling unwell with 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:

  1. Seek medical advice for a sore throat
  2. A child with strep throat should stay away from school to avoid spreading the infection to other children.
  3. Teach children good hygiene to prevent the spread of germs

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.

How can Rheumatic Fever be treated or cured?

Rheumatic fever can be completely prevented by the oldest antibiotic available – penicillin. Professor Liesl Zühlke, a Paediatric Cardiologist and Director of the Children’s Heart Disease Research Unit, further explains, “Effective preventive 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”.

How can Rheumatic Fever and RHD be prevented?

Rheumatic fever and resulting RHD are driven by poverty affecting 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.

Access to reliable and quality primary care is one of the most critical elements of RF/RHD prevention. This includes front line health workers who are trained to recognise and treat strep throat and access to penicillin to treat strep throat and prevent Rheumatic Fever. Long-term prevention will be accomplished through systematic and determined efforts toward poverty eradication and progressive socio-economic development.

What can communities do?

On the local level, schoolteachers 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.

This news piece was adapted from an article published by the Heart and Stroke Foundation South Africa (HSFSA) on July 28, 2020. Read the full article here.