1030 Are we doing enough to contain and eliminate rheumatic fever (RF)?

Any medical student would immediately and correctly recognize that the answer to the above question must be “no,” but s/he would almost certainly not be able to expand on why or where we are failing. For starters, would the medical students know that the first week of August has, since 1989, been promulgated by the National Department of Health as National Rheumatic Fever Week? Again, why should they know, given that the nation is largely unaware of this. Significantly, an internet search lists only a couple of references to the week in 2010 (SA Medical Association calendar and Transmed Medical Aid), and a number of others publicizing the occasion between 2007 and 2009). As pointed out by Mayosi in a recent SA Medical Journal editorial, this lack of awareness in no way signifies that RF is under control in South Africa, and he goes on to show that despite clear management guidelines having been published in 1997 and a declaration on control and a programme proposal by the Pan African Society of Cardiology in 2006, not nearly enough is being done in the country. The Heart of Soweto Study has shown that rheumatic heart disease is the initial manifestation of RF in one-third of patients studied in 2006/7, leading Mayosi to make a strong case for primary detection and prevention. However research from Cape Town also shows a) that there is extremely poor adherence to national guidelines on the prevention of RF, and b) partly as a result of such non-adherence but also because of inadequate infrastructure there is significant under-reporting of RF (which has been a notifiable disease for 20 years). Mayosi cites four pillars of rheumatic heart disease control: 1) Education of all stakeholders on all aspects of RF (clearly not happening if hardly anyone is aware of National RF Week); 2) Primary prevention of RF through syndromic treatment of suspected streptococcal sore throat (utilizing diagnostic algorithms rather than cultures); 3) secondary prevention through register-based penicillin prophylaxis; and 4) surveillance through notification of acute RF. The country embraced the concept of ke nako (it is time) for the 2010 FIFA World Cup, surely it is also time (in fact long overdue) to do more about eliminating rheumatic fever.

Read more:
S Afr Med J 2010; 100: 506 2006; 96: 206-8 2005; 95: 52-6
Eur Heart J 2010; 31: 719-27
Circulation 2009; 120: 709-13