In the United States and many parts of the world, streptococcal infections can be treated early with penicillin and pose a minimal threat to health. However, for people living in areas with limited access to health care, untreated infections can pose serious health consequences. This includes developing rheumatic heart disease, a potentially fatal condition. In 2021, researchers gathered for a three-day workshop to discuss how to coordinate global research to better prevent and treat these late-stage risks. Their findings were published as a special supplement. BMJ Global Health.
Dr. Mary Masterson, director of the Implementation Science Program within NHLBI’s Center for Translational Research and Implementation Science, summarizes these findings and the need for additional research to eliminate this preventable disease. .
What is rheumatic heart disease?
Infections caused by bacterial group A streptococcus It can manifest in a variety of ways, including a sore throat and sore skin. If an infection is not treated early or occurs repeatedly, the body may respond by attacking itself. This is called acute rheumatic fever. This autoimmune response can affect various parts of the body, including the heart. Advanced stages require long-term care, monitoring, and treatment. When acute rheumatic fever progresses to rheumatic heart disease, surgery is often required to replace or repair damaged heart valves.
Who is affected by rheumatic heart disease?
According to the Global Burden of Disease Study, rheumatic heart disease affects more than 40 million people worldwide and causes more than 300,000 deaths each year. Other studies estimate that this condition is responsible for 663,000 cases of severe heart failure annually.
Children, young people and women living in regions with limited economic resources, such as sub-Saharan Africa and Southeast Asia, are particularly affected. This condition is often thought of as a condition of poverty, and although it has been largely eradicated in countries like the United States, it still exists.
How can rheumatic heart disease be prevented?
Ending rheumatic heart disease requires sustained funding, scientific collaboration, and community-based interventions, including awareness-raising.
First, disease surveillance, or identifying ways to track the spread of Group A. streptococcus Infectious diseases (group A streptococcus) are essential. This includes identifying regions and areas with high incidences and cases of acute rheumatic fever. Echocardiography, a type of cardiac imaging test, is used for early detection and diagnosis. It is also used in the diagnosis and evaluation of rheumatic heart disease.
Identification of areas with high numbers of cases could lead to scalable, community-based efforts to prevent and treat infections.
Examples include increasing awareness of health care providers and community members about common symptoms of infectious diseases. Ensuring that people have access to resources such as soap and water for handwashing is also important to reduce the risk of exposure. It is also important to offer testing to those at high risk. Further efforts may be undertaken in public settings such as schools and health centers to diagnose, treat and manage infectious diseases.
Vaccines are still needed and will complement these efforts. Eight vaccine candidates are currently being studied. The goal is for at least one to advance to larger trials to see if it can ultimately be proven safe and effective in reducing the risk of group A streptococcal infections.
How does initial treatment of infection make a difference?
Antibiotics can reduce the risk of a group A streptococcal infection progressing to acute rheumatic fever by 70 to 80% if given early, such as within the first 9 days after infection. Infections identified at a later stage may also benefit from treatment to reduce the risk of group A streptococcal infection progressing to rheumatic heart disease. In this case, lifelong antibiotics are an option. Many other things are also needed. Further research is also needed to understand transmission routes in countries particularly affected by rheumatic heart disease. This provides information on and supports the use of appropriate treatment options to be used at different stages.
What can be done to support late-stage treatment?
Four out of five cases of rheumatic heart disease are detected too late and heart surgery is the only option. Every year, more than 100,000 patients with rheumatic heart disease require surgery. However, most of those affected live in areas where access to surgery is limited. This is where future research could change these results. Investments made to support local health infrastructure have the potential to reach rural populations and provide affordable surgical options. Cost-effective cardiac centers have already been established in some regions, such as India, the Cayman Islands, and parts of Africa. Expanding access to technology, medical training, and culturally responsive research are examples of other ways science can help more people access treatments.
What can NHLBI do to eliminate rheumatic heart disease?
Eliminating rheumatic heart disease is within our lifetimes, but it will take everyone working together. This includes researchers, health care providers, community members, people working in government and non-government organizations, and people affected by this condition. Ensuring sustainable change requires everyone at the table and a multi-level response. In Pinar del Río, a large Cuban province, this approach and the support of the World Health Organization have nearly eradicated the condition. To support this research, it would also be beneficial to use models and responses like those used for HIV and SARS-CoV-2, the virus that causes coronavirus (COVID-19).
The purpose of sharing the research gaps and opportunities identified at the workshop is to stimulate further research and encourage innovative strategies to achieve these outcomes. This requires efforts across the scientific spectrum of basic research, clinical research, and implementation science. Furthermore, leveraging established and innovative models to eradicate rheumatic heart disease can provide a global model for the prevention and treatment of other cardiovascular diseases.
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To read, BMJ Global Health supplement, visit https://gh.bmj.com/content/8/Suppl_9.
To view resources for the NHLBI “Eradication of Rheumatic Heart Disease: Assessing Research Challenges and Opportunities” workshop, visit https://www.nhlbi.nih.gov/events/2021/eradication-rheumatic-heart-disease Please visit -assessing-research-. Challenges and opportunities.
