Rates Of Rheumatic Heart Disease Research Articles

Prevalence and pattern of rheumatic valvular heart disease in Africa: Systematic review and meta-analysis, 2015-2023, population based studies.

Rheumatic heart disease is a global health concern with a persistently high incidence in developing countries, including Africa. It has a significant economic, morbidity, and mortality burden, particularly for children and young adults during their most productive years. However, in the last ten years, the extent of its impact in Africa has remained unclear. Limited studies conducted on the continent have reported diverse prevalence rates of rheumatic heart disease. As a result of these, the study aimed to aggregate and synthesize findings from population-based studies to offer a comprehensive and updated overview of rheumatic heart disease prevalence and pattern at the African level. The studies were identified through a comprehensive literature search of the electronic databases, including PubMed, Google Scholar, Web searches, and manual searches. The descriptive information for the study is presented in the table, and the quantitative results are presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The pooled estimate of the prevalence of rheumatic heart disease was computed by a random effects model. Out of 22 population-based studies analyzed using random-effects, the pooled magnitude of rheumatic heart disease was found to be 18.41/1000 (95% CI: 14.08-22.73/1000). This comprised definite cases of rheumatic heart disease at a prevalence rate of 8.91/1000 (95% CI: 6.50-11.33/1000) and borderline cases at a prevalence rate of 10.69/1000 (95% CI: 7.74-13.65/1000). The combined prevalence of rheumatic heart disease in males was almost equivalent to that in females. Mitral valve regurgitation was the predominant valve affected by rheumatic heart disease, accounting for approximately 73%. This study analysis found the prevalence of rheumatic heart disease in Africa is high. Because of this, policies and interventions should give attention to prioritize continuous population based active surveillance for early detection of cases to the reduction of rheumatic heart disease sequel, especially in the children and adolescent population.

A Rare Case of Lutembacher’s Syndrome

Lutembacher’s syndrome, a rare cardiac condition characterised by the combination of congenital Atrial Septal Defect (ASD) and acquired mitral stenosis, presents significant clinical challenges. Hereby, the authors present a case report of a 28-year-old female exhibiting mild symptoms, including dysapnoea, intermittent palpitations, and lower limb swelling. Examination revealed characteristic findings, including elevated jugular venous pressure, cardiomegaly, and murmurs indicative of mitral stenosis and tricuspid regurgitation. Transthoracic echocardiography confirmed the presence of ASD and moderate mitral stenosis. The patient was ultimately diagnosed with Lutembacher’s syndrome. Prompt initiation of rheumatic heart disease prophylaxis and diuretics led to symptomatic improvement. The present case underscores the need for early recognition and intervention in Lutembacher’s syndrome, particularly in regions with high rates of rheumatic heart disease. Future research should focus on optimising treatment strategies to enhance patient outcomes. Sharing such cases contributes to a deeper understanding of this complex condition and advocates for improved management approaches.

Heart failure among Indigenous and non-Indigenous Australians in remote Central Australia.

There is a paucity of data on the burden of heart failure (HF) in Central Australia, the most populous Indigenous region in the country. To characterize Indigenous and non-Indigenous Australians with HF in Central Australia. Consecutive patients with HF and reduced ejection fraction <50% were included for the period 2019 to 2021. Clinical, echocardiographic and major adverse cardiovascular events (MACE) data were collected. Four hundred twenty-four patients with HF were included (70% Indigenous, 59% male; follow-up 2.2 ± 0.5 years). Indigenous Australians were younger (53 ± 15 vs 68 ± 13 years, P < 0.001) with higher rates of rheumatic heart disease (18% vs 1%, P < 0.001), diabetes (63% vs 33%, P < 0.001) and severe chronic kidney disease (CKD; 32% vs 7%, P < 0.001). HF was more prevalent among Indigenous (138 [95% confidence interval (CI), 123-155] per 10 000) compared with non-Indigenous Australians (53 [95% CI,44-63] per 10 000), particularly among younger individuals and females. There were similar HF aetiologies between groups. Guideline-directed medical therapy (GDMT) was suboptimal and similar between the groups: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (64% vs 67%, P = 0.47) and β-blockers (68% vs 71%, P = 0.47). Indigenous Australians had a significantly higher rate of MACE (54% vs 28%, P < 0.001) and death from any cause (24% vs 13%, P = 0.013). HF is more than two times as prevalent among Indigenous Central Australians, particularly among younger individuals and females. Despite similar HF aetiologies and GDMT, MACE and mortality outcomes are higher in Indigenous individuals with HF. These data have implications for efforts to close the Indigenous gap in morbidity and mortality.

Secondary Prevention of Rheumatic Heart Disease in Nepal: Are We Going Backward?

A secondary level of prophylaxis has proven to be the most successful in Nepal, a country with an endemic rate of rheumatic heart disease, in combating the severe issues associated with rheumatic heart disease. The use of benzathine penicillin G in secondary prophylaxis of rheumatic heart disease, recommended by several guidelines, has been increasingly abandoned in Nepal due to a lack of national guidelines and the termination of the prior programs. The use of oral penicillin and alternative oral antibiotics, which are less effective in preventing the recurrence of acute rheumatic fever, is on the rise. Nepal urgently needs to develop new national guidelines and ensure their effective implementation in order to slow the increase in the number of rheumatic heart disease patients. In this article, we explore the limitations, challenges, and advantages of using the consensus-supported intramuscular benzathine penicillin G as the first-line drug for the secondary prevention of rheumatic heart disease.

Prevalence of latent structural heart disease in Nepali schoolchildren.

The present study aimed to quantify the burden of structural heart disease in Nepali children. We performed a school-based cross-sectional echocardiographic screening study with cluster random sampling among children 5-16 years of age. Between December 2012 and January 2019, 6573 children (mean age 10.6 ± 2.9 years) from 41 randomly selected schools underwent echocardiographic screening. Structural heart disease was detected in 14.0 per 1000 children (95% CI 11.3-17.1) and was congenital in 3.3 per 1000 (95% CI 2.1-5.1) and rheumatic in 10.6 per 1000 (95% CI 8.3-13.4). Rates of rheumatic heart disease were higher among children attending public as compared to private schools (OR 2.8, 95% CI 1.6-5.2, p = 0.0001). Rheumatic heart disease accounted for three out of four cases of structural heart disease and was more common among children attending public as compared to private schools.

A community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia

BackgroundIn Australia’s north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education. Our aim is to determine how the model was experienced by study participants.MethodsThis is a two-year, outreach-to-household, pragmatic intervention implemented by Aboriginal Community Workers in three remote communities. The qualitative component was shaped by Participatory Action Research. Yarning sessions and semi-structured interviews were conducted with 14 individuals affected by, or working with, ARF/RHD. 31 project field reports were collated. We conducted a hybrid inductive-deductive thematic analysis guided by critical theory.ResultsAboriginal Community Workers were best placed to support two of the six domains: housing and environmental health support and health navigation. This was due to trusting relationships between ACWs and families and the authority attributed to ACWs through the project. ACWs improved health literacy and supported awareness and empowerment; but this was limited by disease complexities. Consequently, ACWs requested more training to address knowledge gaps and improve knowledge transfer to families. ACWs did not have skills to provide health professionals with education or ensure health and education services participated in ARF/RHD. Where knowledge gain among participant family members was apparent, motivation or structural capability to implement behaviour change was lacking in some domains, even though the model was intended to support structural changes through care navigation and housing fixes.ConclusionsThis is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable individual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.

Investigation of failure modes of explanted porcine valves in the mitral position.

BackgroundPorcine valves are used for mitral valve replacement, but the limited long-term durability has restricted the application in younger patients. Degenerated porcine mitral valves were explanted to analyze the failure modes and damage characteristics.MethodsTwelve porcine valves were explanted via secondary mitral valve replacement surgery. Microcomputed tomography scanning, morphological and pathological examinations were performed to classify the cusp tears, calcification, and pannus formation. The causes of valve deterioration were subsequently analyzed.ResultsThe mean age at first implantation was 45.42±19.58 years (range, 11–64 years). The mean duration of implantation was 9.39±4.14 years (range, 4.25–18.75 years). The indications for first surgery were rheumatic heart disease in 8 patients (66.67%), infective endocarditis in 2 patients (16.67%), degenerative valvular disease in one patient (8.33%), and congenital heart disease in one patient (8.33%). Type I cusp tears and commissural dehiscence that occurred near the stent post position were found in 6 (50%) and 5 (41.67%) valves, respectively. Calcification was detected in 6 (50%) cases, and pannus was found in most valves (91.67%).ConclusionsLeaflet damage occurred near the stent posts area was the main failure mode of porcine mitral valves in this study. Patients who undergo the first surgery at younger age, the higher prevalence rate of rheumatic heart disease, the structure of bioprosthetic porcine valve, and left ventricular stresses could be considered as the main factors causing valve deterioration.

Cardiac Surgery and Small Island States: A Bridge Too Far?

Small island developing states (SIDS) make up nearly 1% of the world's population, with 65 million people across 58 countries. Small island developing states have some of the highest rates of rheumatic heart disease in addition to a substantial burden of congenital heart defects and a growing burden of ischemic heart disease. Here, we present an overview of cardiac surgical services in SIDS, with a focus on Papua New Guinea, the Maldives, and Aruba. We performed a literature review using the PubMed/MEDLINE and Google Scholar databases to identify articles describing cardiac surgery services in SIDS. Case studies of the history and current state of cardiac surgery in Papua New Guinea, the Maldives, and Aruba were developed and informed by local clinical experience. Nine SIDS have independent cardiac surgical centers and 5 SIDS have local centers supported by visiting teams. Papua New Guinea started cardiac surgery in 1993 and is served by a public center, performing nearly 100 cardiac surgeries per year. The Maldives introduced cardiac surgery services in 2018, with 1 local cardiac surgeon supported by Nepalese cardiac surgeons, performing 33 cardiac surgeries in 15 months. In Aruba, no local cardiac center exists and over 150 patients are sent abroad for cardiac surgery, representing 12% of total health spending. Small island developing states have limited availability of cardiac surgery but pressing clinical needs. Independent cardiac centers exist with acceptable outcomes and lower costs than foreign treatment, which suggests the need to strengthen regionalization models to deliver cardiac surgical care in SIDS.

Prevalence of rheumatic heart disease in school children aged 6–15 years

Objective The aim of the study was to detect the prevalence of rheumatic heart disease among school children aged 6–15 years old. Background Acute rheumatic fever is a disease that affects skin, subcutaneous tissue, joints, brain and heart. Before the availability of echocardiography, the diagnosis of rheumatic carditis depended upon clinical evidence of valvulitis. Nowadays, patients with definite rheumatic fever or suspected cases should undergo echocardiography to identify carditis. Patients and methods A permission was obtained from the ethical committee on the research. This study was done on 5000 student aged 6–15 years. The children had comprehensive history taking and clinical examination for signs of rheumatic heart disease. Those with any abnormality in history or clinical examination were investigated by echocardiography. Results A total of 5000 school children aged 6–15 years were included in this study. An abnormal cardiac examination and abnormal history were reported in 48 students. Overall, 13 students refused to undergo echocardiography. The result of echocardiography done was as follows: five cases had definite rheumatic heart disease, 10 cases had mitral regurge not meeting the criteria of rheumatic heart disease, one case had aortic regurge not meeting the criteria, one case had a ventricular septal defect, and the others were normal. Conclusion The use of echocardiography as diagnostic criteria of rheumatic heart disease can prevent both overdiagnosis and underdiagnosis of that disease. The prevalence rate of rheumatic heart disease in our study was found to be one per thousand (0.1%), which is less than other studies done in Egypt.

Concerns for efficacy of a 30-valent M-protein-based Streptococcus pyogenes vaccine in regions with high rates of rheumatic heart disease.

The prevalence of rheumatic heart disease (RHD) in the Aboriginal population of the Australian Northern Territory is high, and Streptococcus pyogenes skin infections likely contribute to this. A promising candidate S. pyogenes “30mer” vaccine is composed of 30 pharyngitis associated type-specific antigens from the S. pyogenes M protein. Cross opsonisation experiments suggest that 30mer vaccine protection may extend to non-cognate emm types. A new “emm cluster” scheme for classifying M protein is based on the full-length coding sequence, and correlates with functional and immunological properties, and anatomical tropism. Twenty-seven years of research in the Northern Territory has yielded 1810 S. pyogenes isolates with clinical and emm type data. The primary aim was to analyse these data with reference to the emm cluster scheme and cross opsonisation information, to inform estimation of 30mer vaccine efficacy in the Northern Territory. The isolates encompass 101 emm types. Variants of cluster A-C were enriched in throat isolates, and variants of emm cluster D enriched in skin isolates. Throat isolates were enriched for 30mer vaccine cognate emm types in comparison with skin isolates of which only 25% were vaccine emm types. While cross opsonisation data indicates potential for enhancing 30mer vaccine coverage, more than one third of skin isolates were within 38 emm types untested for cross opsonisation. Emm cluster D variants, in particular emm cluster D4, were not only all non-cognate with the vaccine, but were abundant and diverse, and less likely to be cross-opsonisation positive than other emm clusters. Long term persistence of many emm types in the study area was revealed. It was concluded that the 30mer vaccine efficacy in the Northern Territory will likely require both cross protection, and additional measures to elicit immunity against variants of emm cluster D.

Effect of anaemia on the diagnosis of rheumatic heart disease using World Heart Federation criteria

There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries. To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening. A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared. Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6-3.3%) and non-anaemic children (1.3%, 95% CI 0.3-2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012). Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.

Community-based participatory action research on rheumatic heart disease in an Australian Aboriginal homeland: Evaluation of the ‘On track watch’ project

Strategies to date have been ineffective in reducing high rates of rheumatic heart disease (RHD) in Australian Aboriginal people; a disease caused by streptococcal infections. A remote Aboriginal community initiated a collaboration to work towards elimination of RHD. Based in ‘both-way learning’ (reciprocal knowledge co-creation), the aim of this study was to co-design, implement and evaluate community-based participatory action research (CBPAR) to achieve this vision. Activities related to understanding and addressing RHD social determinants were delivered through an accredited course adapted to meet learner and project needs. Theory-driven evaluation linking CBPAR to empowerment was applied. Data collection comprised focus groups, interviews, observation, and co-development and use of measurement tools such as surveys. Data analysis utilised process indicators from national guidelines for Aboriginal health research, and outcome indicators derived from the Wallerstein framework. Findings include the importance of valuing traditional knowledges and ways of learning such as locally-meaningful metaphors to explore unfamiliar concepts; empowerment through critical thinking and community ownership of knowledge about RHD and research; providing practical guidance in implementing empowering and decolonising principles / theories. Lessons learned are applicable to next stages of the RHD elimination strategy which must include scale-up of community leadership in research agenda-setting and implementation.

Echocardiography in Pregnant Indigenous Australians: Need for Screening?

The Indigenous population of Australia has one of the highest rates of rheumatic heart disease (RHD) globally. RHD is more common in females and peak incidence corresponds with child-bearing age. Significant valvular disease can complicate pregnancy. In the Northern Territory, pregnant women are referred for echocardiogram if there are signs or symptoms of cardiac pathology or a history of RHD. To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of RHD. A retrospective review of all echocardiograms performed between 2014–2018 for an indication relating to pregnancy was completed. Data included indication, clinical history, echocardiographic findings and location of delivery. A total of 322 cases with echocardiography during pregnancy were reviewed, 195 Indigenous and 127 non-indigenous women (mean age 25 vs 30 years, p-value <0.01). Indigenous women had significantly higher rates of abnormal echocardiograms (35.9% vs 10%, p-value <0.01) and higher burden of rheumatic fever/RHD (39.4% vs 0.8% p-value <0.01). Moderate or severe valve lesions were detected in 26 (13.3%) indigenous women and 11 (5.6%) had previous cardiac surgery. Transfer to a tertiary centre with valve intervention services available was required for 12 (6.2%) Indigenous women. In the Northern Territory, Indigenous pregnant women have significantly higher rates of abnormal echocardiograms compared with non-indigenous counterparts. This is mainly due to RHD. Data suggests that Indigenous pregnant women are being under serviced by the current referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.

Heart Failure Treatment in Northern Australia: Can We Do Better?

Background: Heart failure (HF) is a significant cause of disease burden for Indigenous Australians. Understanding the prevalence, aetiology and treatment in Indigenous populations is vital to improving health outcomes. Aim: To compare the management of systolic HF between Indigenous and non-indigenous populations in the Northern Territory. Methods: A retrospective study of systolic heart failure admissions between July 2016 and July 2017 was performed. Data collected included patient demographics, co-morbidities, echocardiographic findings, medical therapy and 12-month outcomes. Results: There were 102 patients; 51 Indigenous and 52 non-indigenous (prevalence 77/100,000 vs 29/100,000). Indigenous patients were younger (52 years vs 72 years, p-value <0.01) and more likely female (45% vs 27%, p-value <0.01) with higher rates of rheumatic heart disease (15.6% vs 0% p-value <0.01) and chronic kidney disease (74.5% vs 50% p-value <0.01). Ischaemic cardiomyopathy was the most common aetiology in both groups (41.2%, 44%). Beta-blockers were the most prescribed treatment in both groups (86.2%, 75%) with lower rates of ACE-inhibitor (68.6%, 63.4%) and aldosterone antagonist (66.6%, 54%). At 12 months, treatment prescription had not reduced significantly for Indigenous patients. Readmission rates for heart failure were high (74.5% vs 61.5%) with 6 deaths in each group. Conclusion: Indigenous patients are younger, more likely to be female and have a markedly higher prevalence of systolic heart failure than their non-indigenous counterparts. Their burden of chronic disease is significant and rehospitalisation rates are high. Addressing the underlying causes of heart failure and barriers to treatment adherence are necessary to reduce the disease burden.

Arrhythmia care in Africa.

Data on cardiovascular disease, including arrhythmias, in Africa is limited. However, the burden of cardiovascular disease appears to be on the rise. Recent global data suggests an increase in atrial fibrillation rates despite declining rates of rheumatic heart disease. Atrial fibrillation is also associated with increased mortality in Africa. Current management with medical therapy is sub-optimal and ablation procedures, inaccessible. Atrial fibrillation is also an independent risk factor for death in patients with rheumatic heart disease. Sudden cardiac deaths from ventricular arrhythmias are under-recognized and inadequately treated with very high rates out of hospital cardiac arrest due to poor education of the general public on cardiopulmonary resuscitation skills and lack of essential healthcare infrastructure. Use of cardiac devices such as implantable defibrillators and pacemakers is low with significant regional variations and is almost non-existent in sub-Saharan Africa. There is a great unmet need for arrhythmia diagnosis and management in Africa. Governments and healthcare stakeholders need to include cardiovascular disease as a healthcare priority given the rising burden of disease and associated mortality.

Genomic resources and draft assemblies of the human and porcine varieties of scabies mites, Sarcoptes scabiei var. hominis and var. suis.

BackgroundThe scabies mite, Sarcoptes scabiei, is a parasitic arachnid and cause of the infectious skin disease scabies in humans and mange in other animal species. Scabies infections are a major health problem, particularly in remote Indigenous communities in Australia, where secondary group A streptococcal and Staphylococcus aureus infections of scabies sores are thought to drive the high rate of rheumatic heart disease and chronic kidney disease.ResultsWe sequenced the genome of two samples of Sarcoptes scabiei var. hominis obtained from unrelated patients with crusted scabies located in different parts of northern Australia using the Illumina HiSeq. We also sequenced samples of Sarcoptes scabiei var. suis from a pig model. Because of the small size of the scabies mite, these data are derived from pools of thousands of mites and are metagenomic, including host and microbiome DNA. We performed cleaning and de novo assembly and present Sarcoptes scabiei var. hominis and var. suis draft reference genomes. We have constructed a preliminary annotation of this reference comprising 13,226 putative coding sequences based on sequence similarity to known proteins.ConclusionsWe have developed extensive genomic resources for the scabies mite, including reference genomes and a preliminary annotation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13742-016-0129-2) contains supplementary material, which is available to authorized users.

Mitochondrial Genome Sequence of the Scabies Mite Provides Insight into the Genetic Diversity of Individual Scabies Infections.

The scabies mite, Sarcoptes scabiei, is an obligate parasite of the skin that infects humans and other animal species, causing scabies, a contagious disease characterized by extreme itching. Scabies infections are a major health problem, particularly in remote Indigenous communities in Australia, where co-infection of epidermal scabies lesions by Group A Streptococci or Staphylococcus aureus is thought to be responsible for the high rate of rheumatic heart disease and chronic kidney disease. We collected and separately sequenced mite DNA from several pools of thousands of whole mites from a porcine model of scabies (S. scabiei var. suis) and two human patients (S. scabiei var. hominis) living in different regions of northern Australia. Our sequencing samples the mite and its metagenome, including the mite gut flora and the wound micro-environment. Here, we describe the mitochondrial genome of the scabies mite. We developed a new de novo assembly pipeline based on a bait-and-reassemble strategy, which produced a 14 kilobase mitochondrial genome sequence assembly. We also annotated 35 genes and have compared these to other Acari mites. We identified single nucleotide polymorphisms (SNPs) and used these to infer the presence of six haplogroups in our samples, Remarkably, these fall into two closely-related clades with one clade including both human and pig varieties. This supports earlier findings that only limited genetic differences may separate some human and animal varieties, and raises the possibility of cross-host infections. Finally, we used these mitochondrial haplotypes to show that the genetic diversity of individual infections is typically small with 1–3 distinct haplotypes per infestation.

Streptococcal pharyngitis in schoolchildren in Bamako, Mali.

Group A streptococcus (GAS) pharyngitis is associated with high rates of rheumatic heart disease in developing countries. We sought to identify guidelines for empiric treatment of pharyngitis in low-resource settings. To inform the design of GAS vaccines, we determined the emm types associated with pharyngitis among African schoolchildren. Surveillance for pharyngitis was conducted among children 5-16 years of age attending schools in Bamako, Mali. Students were encouraged to visit a study clinician when they had a sore throat. Enrollees underwent evaluation and throat swab for isolation of GAS. Strains were emm typed by standard methods. GAS was isolated from 449 (25.5%) of the 1,759 sore throat episodes. Painful cervical adenopathy was identified in 403 children (89.8%) with GAS infection and was absent in 369 uninfected children (28.2%). Emm type was determined in 396 (88.2%) of the 449 culture-positive children; 70 types were represented and 14 types accounted for 49% of isolates. Based on the proportion of the 449 isolates bearing emm types included in the 30-valent vaccine (31.0%) plus nonvaccine types previously shown to react to vaccine-induced bactericidal antibodies (44.1%), the vaccine could protect against almost 75% of GAS infections among Bamako schoolchildren. Two promising strategies could reduce rheumatic heart disease in low-resource settings. Administering antibiotics to children with sore throat and tender cervical adenopathy could treat most GAS-positive children while reducing use of unnecessary antibiotics for uninfected children. Broad coverage against M types associated with pharyngitis in Bamako schoolchildren might be achieved with the 30-valent GAS vaccine under development.

Short- and long-term outcomes after valve replacement surgery for rheumatic heart disease in the South Pacific, conducted by a fly-in/fly-out humanitarian surgical team: A 20-year retrospective study for the years 1991 to 2011

Fiji has one of the highest rates of rheumatic heart disease in the world. Humanitarian fly-in/fly-out surgical teams, including Open Heart International, have been conducting valve replacement surgery in Fiji since 1991. We sought to determine the short- and long-term outcomes of valve replacement for rheumatic heart disease. The Open Heart International team performed surgery on 167 patients from 1991 to 2011. Complete follow-up data to death or last evaluation on 149 patients (89.2%) and morbidity data for 152 patients (91%) were extracted from medical records. Patients' average age at the time of surgery was 26.1 years, with the majority being female (63.5%). Valves replaced were isolated mitral valves (52%), isolated aortic valves (19%), and multiple valves (29%). The cumulative mortality rate at 30, 60, and 90 days and at 1, 5, and 10 years was 2.4%, 6.0%, 8.4%, 12.0%, 19.8%, and 23.9%, respectively. Major adverse valve-related events-free survival was 10.1 years (95% confidence interval [CI], 8.32-11.94). After adjusting for confounders, female patients were 3.03 times more likely to die postoperatively than male patients (odds ratio [OR], 3.03; 95% CI, 1.23-7.69). Patients undergoing isolated valve replacement were less likely to have a morbidity event than those undergoing multiple valve replacement (isolated mitral 67% less likely [OR, 0.33; 95% CI, 0.12-0.93] and isolated aortic 76% less likely [OR, 0.34; 95% CI, 0.06-0.96]). The majority of people undergoing valve replacement for rheumatic heart disease have good outcomes. Mortality and morbidity rates at 1 and 5 years, particularly for female patients, are cause for concern and indicate a need for evaluation of resources toward systematic long-term postoperative surveillance and medical management.

Epidemiological survey of Rheumatic fever, Rheumatic heart disease and Congenital heart disease among school children in Kathmandu valley of Nepal

Background and Aims: Rheumatic Fever, Rheumatic Heart Disease and Congenital Heart disease are the most common cardiac problems in school children. Prior studies have reported different prevalence rate of Rheumatic Heart Disease among different groups of population of Nepal. The aim of this study was to estimate the prevalence of Rheumatic Fever, Rheumatic Heart Disease and Congenital Heart Disease among school children in Kathmandu Valley of Nepal. Methods: Cardiac screening of 34,876 school children from 115 randomly selected public schools from two cities of Kathmandu Valley (Kathmandu and Lalitpur) was done. Cases with abnormal findings in auscultation underwent echocardiography and the diagnosis was confirmed. Results: The prevalence of Congenital Heart Disease was noted to be 1 per thousand and prevalence of Rheumatic Heart Disease was found to be 0.90 per thousand (in the age group 5-16 years) with the most common lesion being Mitral Regurgitation. No significant statistical difference was noted between male and female students in both the cases of Rheumatic Heart Disease and Congenital Heart Disease. No cases of Acute Rheumatic Fever were noted. Conclusion: The prevalence of Rheumatic Heart Disease among school children in Kathmandu valley was noted to be lower than reported in similar previous studies. Primary and secondary prevention programs of RF/RHD have been effective in Nepal and are needed to be strengthened and expanded to further reduce the burden of these diseases. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 1-5 DOI: http://dx.doi.org/10.3126/njh.v10i1.9738