The Heart and Stroke Foundation South Africa (HSFSA) has commemorated Rheumatic Fever Week, from Saturday, 3 August to Friday, 9 August, which aims to raise ‘awareness about the harm’ Rheumatic Fever (RF) can cause to young children and individuals.
Rheumatic Fever Week is a week-long campaign that brings attention to RF as a ‘serious autoimmune disease’, that affects various body parts of a child, including the joints, heart, skin, nervous system and brain.
This occurs when a child’s immune system overreacts to an untreated strep throat.
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RF affects up to 40 million people who live in low-income countries, as well as globally, and claims more than 300 000 lives each year.
According to The Lancet Global Health of May 2021, Sub-Saharan Africa remains the region with ‘the highest prevalence’ of Rheumatic Heart Disease (RHD) in the world, causing about 18 000 deaths annually.
The incidence of Acute Rheumatic Fever (ARF) is 8 to 51 per 100 000 people worldwide, but RF rarely occurs in countries that have more resources available.
RF mostly affects children, adolescents and pregnant women in low- and middle-income countries (LMIC’s), especially where there is widespread poverty and limited access to health services.
Rheumatic Fever: What to know
RF is an ‘abnormal immune reaction’ to a common bacterium called Group A Streptococcus, which is preceded two or three weeks earlier by a bacterial throat infection, commonly called ‘strep throat’.
Streptococcal infections commonly occur in childhood and they usually appear in children between the ages of five and 15, but adults and young children can still contract the illness and become infected.
In certain cases, repeated streptococcal infections can cause the immune system to react against the tissues of the body, including ‘inflammation and scarring the heart valves’. This is what is referred to as RF.
Symptoms that RF patients typically experience include joint pain, fever above 38°C, general feelings of unwellness, shortness of breath, a skin rash, a heart murmur, and, on ‘rare occasions’, uncontrolled body movements.
Cardiac involvement during ARF can result in RHD if left untreated, from which RHD can result from the ‘inflammation and scarring of heart valves’ caused by RF.
Symptoms of heart valve damage associated with RHD can include chest pain or discomfort, swelling of the stomach, hands or feet, shortness of breath, fatigue and a rapid or irregular heartbeat.
If RHD is left untreated, it will lead to further heart valve damage, stroke, heart failure, and even premature death. The disease requires lifelong medication, medical surveillance and often heart valve replacement surgery.
Penicillin can help prevent RF, especially if diagnosed early.
While scientific advances and ongoing research are ‘steps in the right direction’, it takes time for findings to be put into practice. Therefore, continued prevention efforts at the community level are recommended.
This can be achieved by raising community awareness of Group A streptococcal throat infections and the link with RF and RHD.
In addition, improving living conditions, hygiene and access to primary health care should be prioritised.
Preventing subsequent streptococcal infections is ‘crucial’, once RF has been diagnosed in a patient, as this could result in another episode of RF and more damage to the heart valves.
Once diagnosed, the patient should be treated with antibiotics for ‘an extended period of time’, in order to prevent further streptococcal infection.
RF was made a ‘notifiable condition’ in 1989 in South Africa, and the National Department of Health declared the first week of August as National Rheumatic Fever Week.
This was to ‘highlight the need’ to implement proven interventions to reduce the incidence of ARF and the prevalence of RHD in a middle-income country like South Africa, which is also a country with high levels of inequality.
Prevention of infections:
There are practical ways to prevent infections, especially in children. These include:
- Parents, school teachers and other caregivers should be on the lookout for a sore throat and educate children about the necessary precautions to take. A sore throat in the absence of a cold or flu could be a strep throat, which can cause RF.
- A child with a sore throat and suspected strep throat should avoid school to avoid spreading the infection to other individuals.
- The child should be taken to a doctor or clinic if strep throat is suspected.
- Teaching children good hygiene, including hand washing, to prevent the spread of germs is also recommended.
Other key points for adults and children to keep the immune system strong include:
- Consistent sleep (seven to nine hours every night).
- Practicing good hygiene, such as hand washing.
- Exercise moderate-intensely weekly for 150 minutes.
- A healthy diet is also important. This includes all food groups: unrefined starches, lean proteins, good fats and a variety of fruits and vegetables.
- Avoid people who are sick.
- Stress management can also help. With children, it is best to stick to routines.
Additionally, the HSFSA has annually played an important role in ‘disseminating information and knowledge’ regarding the relationship between RF and RHD by conveying empowering messages to parents and caregivers that RHD is, to a large extent, preventable.
‘The organization plays an important role in education and knowledge dissemination for RF, RHD, as well heart disease in general,’ said Prof Pamela Naidoo, HSFSA CEO.
Naidoo further urged parents and caregivers to take responsibility to ensure that their child receives medical care, particularly for very high fever and a ‘fever that does not settle’.
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Picture: RF._.studio / Pexels
