Epidemiology Of Acute Rheumatic Fever Research Articles

Current Situation of Acute Rheumatic Fever and Rheumatic Heart Disease in Latin America and the Caribbean: A Systematic Review.

Background:Rheumatic heart disease (RHD) disproportionately affects low-income and middle-income countries. Latin America and the Caribbean (LAC) have been less represented in scientific literature. We aimed to describe the epidemiology, burden and implemented screening and prevention strategies of RHD in LAC.Methods:We systematically searched PubMed, Embase, LILACS, and SciELO from 1990 to April 2021. Observational and experimental studies that described data on the epidemiology, burden, or prevention/screening strategies of RHD, regardless of age or language, were included. The risk of bias was assessed by previously published tools depending on their study design. Pre-specified data were independently extracted and presented by each topic (epidemiology, burden, prevention/screening). PROSPERO registration number: CRD42021250043.Results:Forty-eight studies out of 1692 non-duplicate records met the eligibility criteria. They were mainly from Brazil, observational in design, and hospital-based. Data on the epidemiology of acute rheumatic fever (ARF) was not recent (most before 2000) with studies describing decreasing incidence through the years. The prevalence of RHD was described in six studies, ranging from 0.24 to 48 per 1,000 among studies evaluating schoolchildren. Nine studies described data based on admissions, ranging from 0.04% to 7.1% in single-center studies. Twenty-four studies assessed the burden of RHD with most of them reporting mortality rates/proportions and complications such as the need for intervention, atrial fibrillation, or embolism. Six preventive strategies were identified that included educational, register-based, and/or secondary prophylaxis strategies. Three well-established echocardiographic screening studies in Brazil and Peru were identified.Conclusions:Most ARF/RHD research in LAC comes from a single country, Brazil where preventive/screening efforts have been conducted. There was a paucity of data from several countries in the region, reflecting the need for epidemiological studies from more countries in LAC which will provide a better picture of the current situation of ARF/RHD and guide the implementation of preventive strategies.

Problems of chronic rheumatic heart disease diagnosis at the present stage

The review refl ects modern data on the epidemiology of acute rheumatic fever and chronic rheumatic heart disease in Russia and the world at present, as well as the dynamics of the prevalence of these diseases over the past decades. Much attention is paid to the issues of modern diagnostics of these conditions by physical, laboratory and instrumental methods. The focus is on the Jones criteria in the diagnosis of acute rheumatic fever in accordance with their revision by the American Heart Association experts in 2015. Taking into account the fact that damage to the valvular apparatus of the heart in acute rheumatic fever is the main disabling outcome of carditis at the present stage, a special place in the article is devoted to the discussion of echocardiographic criteria for valvulitis. The recommendations of the International Expert Council of the World Heart Federation aimed at detecting chronic rheumatic heart disease in patients without a history of acute rheumatic fever diagnosed by ultrasound imaging are also given. Criteria for pathological aortic and mitral regurgitation are presented. The authors believe that extrapolation of modern principles of ultrasound diagnostics of chronic rheumatic heart disease in Russia and their use as screening programs in young people and adolescents will contribute to its early detection and timely selection of patients for secondary prevention of benzathine with benzylpenicillin.

The Epidemiology of Acute Rheumatic Fever In Northland, 2012–2017

Aim: The audit was to establish accuracy and completeness of acute rheumatic fever (ARF) surveillance in Northland for the period 2012–2017 and compare rates of ARF with the previous audit. Methods: Cases of ARF were identified and evaluated through the national surveillance database (EpiSurv), the Northland Rheumatic Fever secondary prophylaxis register and hospital discharges. Cases were included if they were Northland residents and met ARF diagnostic criteria as per the 2014 New Zealand Heart Foundation guidelines. Results: A total of 69 ARF cases met audit criteria, an annualised incidence rate of 7.0/100,000. 93% of cases were Māori. The 5–14 year age group had the highest rates which also demonstrated the greatest disparity between Māori (64.5/100,000), Pacific (54.6/100,000) and Non-Māori/Non-Pacific (1.5/100,000). Ten new cases of ARF were diagnosed in patients aged 20 years or older. Of the 14 ‘medium-to-high-risk’ carditis cases, 6 were older than 15 years. ARF was strongly associated with level of deprivation, with 87% of cases in NZDep8-10. Conclusion: ARF rates among Northland Māori aged 5–14 years (64.5/100,000) remain similar to those in third-world countries. Adults (≥16 years old) showed disproportionate rates of ‘medium-to-high-risk’ carditis. A marginal improvement from the previous audit was seen for Māori despite the Rheumatic Fever Prevention Programme, a discrepancy compared with The Ministry of Health's recent publications which indicate a large improvement in ARF rates for Northland. This audit highlights the significant, ongoing need in Northland for good data collection so ARF prevention efforts can be resourced appropriately.

Update on rheumatic fever in New Zealand

Despite being a relatively affluent nation, New Zealand (NZ) has persistently high rates of acute rheumatic fever (ARF) disproportionally affecting Māori and Pacific people. In 2011 the NZ government launched the Rheumatic Fever Prevention Programme (RFPP) with the stated aims of achieving equity of incidence and outcomes of ARF between Māori/Pacific and other NZ children, and to achieve a reduction in the national incidence of ARF by two-thirds, from 4.0 per 100,000 people in 2011 to 1.4 per 100,000 people by 2017. The three interventions of the RFPP are: (1) improve access to timely diagnosis and treatment for group A streptococcal pharyngitis; (2) increase awareness of ARF; and (3) reduce household crowding and transmission of group A streptococcus. The presentation will cover the epidemiology of ARF in NZ, and discuss issues arising from the RFPP and outcomes.

Letter to the editor

Letter to the editor We would like to applaud the authors of the article "The worldwide epidemiology of acute rheumatic fever (ARF) and rheumatic heart disease (RHD)"¹ for highlighting this important disease which continues needlessly to kill people living in poverty while being largely ignored by the developed world.² We would however like to address some key issues.The authors state that: the evidence of serologic infection is based on one of "a pharyngeal swab culture positive for GABHS, positive rapid GABHS antigen test or rising serologic antibody titers". Very few countries in highly affected regions of the world utilize routine rapid antigen or microbiological testing due to the cost involved. Furthermore, the delay involved in repeat serological testing before a diagnosis can be made, will result in missed diagnoses and tragic consequences. We recommend therefore that elevated serological markers of previous GABHS infection, together with major and minor criteria, are sufficient for a diagnosis of ARF.

Epidemiology of acute rheumatic fever in New Zealand 1996–2005

Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Māori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location. This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996-2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals. New Zealand's annual ARF rate was 3.4 per 100,000. ARF was concentrated in certain populations: 5- to 14-year-olds, Māori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Māori and Pacific peoples' rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 for Māori and 20.7 for Pacific peoples. Of all cases, 59.5% were Māori or Pacific children aged 5-14 years, yet this group comprised only 4.7% of the New Zealand population. ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics.

Group A Streptococcal Isolates Temporally Associated with Acute Rheumatic Fever in Hawaii: Differences from the Continental United States

The annual incidence of acute rheumatic fever (ARF) in Hawaii has remained several times higher than that in the continental United States, particularly among ethnic Polynesians. The emm types of Streptococcus pyogenes that are associated with this nonsuppurative complication have, to our knowledge, not been previously reported in Hawaii. Patients with ARF were identified through an active surveillance system at Kapiolani Medical Center (Honolulu, HI), the only pediatric tertiary care referral hospital in Hawaii. Specimens were obtained by throat culture from patients who met the Jones criteria for ARF at the time of presentation (63 patients), prior to penicillin treatment, and from consenting family contacts (10 individuals). Eight patients and 2 close family contacts with positive throat culture results were identified from February 2000 through December 2005. Group A streptococci isolates were characterized by emm sequence typing. Unusual emm types were temporally associated with the onset of ARF. Emm types 65/69 (from 2 patients), 71, 92, 93, 98, 103, and 122 were isolated from the 8 patients with ARF, and emm types 52 and 101 were isolated from the 2 household contacts. So-called rheumatogenic emm types and/or serotypes, which were previously associated with ARF in the continental United States, were not found in this study. Instead, emm types that are not commonly included among group A streptococci isolates in the continental United States and that are seldom, if ever, temporally associated with ARF were identified. These findings suggest that unusual group A streptococci emm types play a significant role in the epidemiology of ARF in Hawaii.

Changing Epidemiology of Acute Rheumatic Fever in the United States

Changing Epidemiology of Acute Rheumatic Fever in the United States

The epidemiology of acute rheumatic fever in Indigenous people in north Queensland

Objective: To describe the epidemiology and features of acute rheumatic fever (ARF) in Indigenous people in north Queensland from mid‐1999 to mid‐2004.Methods: Enhanced surveillance, including regular reminder letters to relevant clinicians and computer searches of hospital discharge diagnoses, was implemented to capture cases of ARRResults: Over the five years, 144 episodes of ARF occurred in 133 Indigenous people in seven of the Health Service Districts in north Queensland. The annual incidences of ARF were 61 cases/100,000 Indigenous people in these seven districts, and 54/100,000 throughout north Queensland. The median age of the cases was 12.0 years, and 76% of the cases occurred in children <15 years. More than one‐third of the definite cases were recurrences of ARF, and carditis was present in 42% of all cases.Conclusions: Within north Queensland, the incidences of ARF were greatest in the Cape York and the Torres Strait and Northern Peninsula Area Districts. However, the incidence of ARF in north Queensland is considerably lower than that reported from the Top End of the Northern Territory (NT). Furthermore, there appears to be less chorea and less monoarthritis, but more group A streptococci isolated from throat swabs, in ARF cases in north Queensland compared with those from the Top End of the NT.Implications: There is a need for greater awareness of ARF and its complications among both ARF patients and primary health care workers in the region, and for more reliable mechanisms for recalling patients for their prophylaxis and clinical reviews.

Acute rheumatic fever: a chink in the chain that links the heart to the throat?

Acute rheumatic fever (ARF) remains a major problem in tropical regions, resource-poor countries, and minority indigenous communities. It has long been thought that group A streptococcal (GAS) pharyngitis alone was responsible for acute rheumatic fever; this belief has been supported by laboratory and epidemiological evidence gathered over more than 60 years, mainly in temperate climates where GAS skin infection is uncommon. GAS strains have been characterised as either rheumatogenic or nephritogenic based on phenotypic and genotypic properties. Primary prevention strategies and vaccine development have long been based on these concepts. The epidemiology of ARF in Aboriginal communities of central and northern Australia challenges this view with reported rates of ARF and rheumatic heart disease (RHD) that are among the highest in the world. GAS throat colonisation is uncommon, however, and symptomatic GAS pharyngitis is rare; pyoderma is the major manifestation of GAS infection. Typical rheumatogenic strains do not occur. Moreover, group C and G streptococci have been shown to exchange key virulence determinants with GAS and are more commonly isolated from the throats of Aboriginal children. We suggest that GAS pyoderma and/or non-GAS infections are driving forces behind ARF in these communities and other high-incidence settings. The question needs to be resolved as a matter of urgency because current approaches to controlling ARF/RHD in Aboriginal communities have clearly been ineffective. New understanding of the pathogenesis of ARF would have an immediate effect on primary prevention strategies and vaccine development.

Advances in acquired pediatric heart disease

Acquired heart disease in children may result in significant morbidity and mortality. Advances continue to be made in understanding Kawasaki disease, acute and chronic rheumatic heart disease, infective endocarditis, myocarditis, and dilated cardiomyopathy. The role of superantigens, particularly bacterial toxins, in the pathogenesis of Kawasaki disease continues to be defined. Intravascular ultrasound promises to improve the assessment of coronary arteries in Kawasaki disease. Current recommendations for the long-term management of Kawasaki disease are discussed. Significant changes in the epidemiology of acute rheumatic fever and endocarditis are noted. Updates on the role of echocardiography as well as current therapeutic issues in these diseases are addressed. The application of immunologic and molecular biologic techniques have implicated genetic and immune factors in the pathogenesis of myocarditis and cardiomyopathy. The relationship between viral infection and subsequent dilated cardiomyopathy, as well as the role of autoimmune mechanisms in the pathogenesis of these disorders, remains controversial.

Epidemiology of Acute Rheumatic Fever in a Multiethnic, Multiracial Urban Community: The Miami-Dade County Experience

During the mid-1980s, several US communities experienced outbreaks of acute rheumatic fever (ARF), often involving predominantly white, middle-class individuals living in suburban or rural settings. The medical records of all patients diagnosed with ARF in Miami-Dade County, Florida, between 1984 and 1988 were reviewed. Thirty-five cases met the revised Jones criteria and were considered definite; four additional cases were classified as probable. Carditis was present in 54%. Of the 39 patients, 32 (82%) were black. The annual incidence of ARF among black children aged 5-14 years was 12.25 per 100,000 compared to 0.71 for other (non-Hispanic white plus Hispanic) children (P less than .001). ARF was centered in the inner city, where the incidence among black children reached 15.21. Despite the multiethnic, multiracial character of Miami-Dade County and the rapid influx of immigrants, ARF in this community remains primarily a disease of underprivileged, black inner-city children.

Rheumatic Fever in Warm Climates-Reply

In Reply.— Dr Garcia-Palmieri has very properly emphasized that the epidemiology of acute rheumatic fever relates to the intensity and severity of streptococcal disease, whether it be in the tropics or in temperate climates. Wherever the predisposing factors of inadequate primary medical treatment with crowded living conditions, close person-to-person contact, inadequate nutritional intake, and lowered host defenses exist, acute rheumatic fever can be expected—and the prevalence of rheumatic fever and rheumatic heart disease will not be related to climate, per se, nor to any particular racial or ethnic group. For further information, the reader is referred to the very excellent monographRheumatic Fever and Streptococcal Infectionby Dr Gene H. Stollerman (New York, Grune & Stratton Inc, 1975).

Recent developments in the prevention of rheumatic fever.

Excerpt During the past decade developments in the control and prevention of rheumatic fever have occurred which, when fully applied, should reduce the incidence of a disease that is a major cause ...