Group A Streptococcal Infection, Acute Rheumatic Fever and Rheumatic Heart Disease in the Solomon Islands

Abstract

Abstract Group A Streptococcal (GAS) infection of the upper respiratory tract (and possibly skin) can trigger Acute Rheumatic Fever (ARF), an autoimmune condition if left untreated. Severe or recurrent attacks of ARF that also remain untreated, can lead to a type of permanent cardiac damage known as Rheumatic Heart Disease (RHD). RHD remains a significant cause of morbidity and mortality globally and is rare in developed countries. In Australia, New Zealand (NZ) and the Pacific Region, the disease burden of ARF and RHD amongst Indigenous and Pacific communities remain one of the highest in the world, usually affecting children and young adults. Since a GAS vaccine remains unavailable, the most effective recommended treatment and management strategy to prevent further GAS infections that can lead to ARF and RHD constitute of painful monthly intramuscular injections of Benzathine Penicillin G (BPG). These BPG injections are administered for at least 10 years or more and are referred to as secondary prophylaxis (SP). Due to the pain, formulation and other issues associated with regular BPG injections, adherence to SP remains problematic globally. A new Penicillin that supports better adherence to SP is urgently needed. This work sought to further understand the local context in the Solomon Islands concerning GAS, ARF and RHD. Preliminary findings indicate very high ARF and RHD rates present in the local setting, in addition to issues with access to ARF/RHD prevention measures with BPG. An electronic database to monitor ARF and RHD as a national disease register will be of clinical relevance to the local setting in the Solomon Islands. Research efforts in the Pacific Region contributing towards the generation of a new Penicillin for BPG SP will be of benefit.