Worldwide, in terms of money spent on research, acute rheumatic fever is one of the most neglected diseases there is. Yet, when acute rheumatic fever develops into rheumatic heart disease, it can be deadly.
Perhaps this neglect is a result of it being an uncommon condition in the developed world. But in the developing world it is considered a benchmark of a country’s primary healthcare capabilities or, more to the point, an index of poverty. In South Africa, there are 15.2 cases per 100 000 people and just less than 10% of these are fatal. The condition most commonly affects children between the ages of five and 15 years, whereas only about 20% of first-time attacks occur in adults.
What is rheumatic fever and what makes it such a serious health risk to South Africa’s children?
Because it is an autoimmune disease, acute rheumatic fever has many different symptoms and can affect different parts of the body — the heart, joints, skin and brain. It is not always easy to diagnose in its early stages and usually occurs about two to three weeks after the sufferer has been infected with group A beta-haemolytic streptococcus bacteria, which usually manifest as a strep throat or scarlet fever.
By the time the rheumatic fever has fully developed, it includes a variety of symptoms and the diagnosis is based on the Jones criteria.
Besides the biochemical evidence of streptococcal infection, the major criteria are multiple, painful swollen joints, inflammation of the heart muscle, a rash on the trunk or arms and, at times, abnormal involuntary movements known as Sydenham’s chorea (also known as St Vitus dance), which are jerky twitches and tremors of the fingers, hands and arms.
The minor criteria include a fever, joint pain, evidence of raised inflammation and a previous history of rheumatic fever.
Treatment is a course of antibiotics to kill the bacteria, and penicillin is still the drug of choice for non-allergic patients.
Once a person has suffered from acute rheumatic fever after a strep throat, he or she is at risk of subsequent episodes of the disease. As a preventative measure, doctors can prescribe chronic long-term prophylactic treatment to prevent further infections.
But for some sufferers there is a far more serious complication: an inflammation of the heart that leads to a weakening of the heart valves, referred to as rheumatic heart disease.
The damage caused to the heart valves needs advanced medical procedures or surgery to repair or replace the valve, which obviously presents enormous challenges to our already overstretched and under-resourced public health system.
Sadly, for many sufferers of serious heart valve disease, palliative care is the only option.
But there is a move to introduce new measures for the prevention and control of acute rheumatic fever. The department of health, in collaboration with the World Heart Foundation and the PanAfrican Association of Cardiology, held a ground-breaking conference to develop a common strategy for the control and eradication of rheumatic fever.
It resulted in the formulation of a comprehensive plan for the control of the disease, including surveillance studies of the condition, advocacy campaigns, awareness campaigns and the establishment of national primary and secondary prevention programmes in several African countries.
The health department’s aim is to eradicate the disease in our own lifetime. With political will, a keener interest from the scientific community and adequate funding, this can be achieved.
After all, it has happened before: smallpox has been relegated to the history books and the incidence of polio has been reduced dramatically the world over. For the sake of Africa’s children, let us hope that acute rheumatic fever follows the same path.
This article originally appeared in the Mail & Guardian newspaper as a sponsored feature
Rheumatic fever will be the topic of Bonitas House Call on August 6 on SABC2 at 9am