Saturday, March 5th, 2011 - RHD
A severe lack of awareness, advocacy and political will means hundreds of thousands of children and young adults are victims of rheumatic heart disease (RHD) in the world's poorest countries, according to experts presenting today at the "The Long Tail of Global Health Equity: Tackling the Endemic Non-Communicable Diseases of the Bottom Billion" conference hosted by the Harvard Medical School Department of Global Health and Social Medicine (DGHSM). The conference was organized by Partners In Health (PIH) in collaboration with Brigham and Women's Hospital (BWH), Harvard School of Public Health (HSPH), The Global Taskforce on Expanding Access to Cancer Care & Control in Developing Countries, and the NCDAlliance.

"RHD needlessly kills and disables people living in extreme poverty," said Johanna Ralston, Chief Executive Officer of World Heart Federation from the meeting at Harvard. "High prevalence of the disease has become a marker of poverty and an important factor feeding growing health inequities."

"RHD mainly affects children, adolescents and young adults. It can be prevented using one of the oldest and cheapest antibiotics in the formulary - penicillin," said Dr. Jonathan Carapetis, World Heart Federation expert on RHD and Director of the Menzies School of Health Research in Darwin, Australia. "It has practically been eliminated in wealthy countries and is declining fast in emerging economies but remains devastating among the poorest of the poor."

"The funding required is minimal and in some cases successful control could be achieved by re-prioritizing existing budgets," continued Dr. Carapetis. "In the Pacific Islands, severe RHD patients have to be sent overseas for costly heart valve operations which places a significant burden on the local government budget assigned to RHD. However, it would be possible to run a coordinated control program to prevent progression to severe RHD for only a fraction of the costs of these operations. This would prevent children and young people from getting the heart damage in the first place."

Previous estimates state that more than 15 million people have RHD and that 350,000 people die each year while many more are left disabled.(i) But a recent study from Nicaragua has suggested that these data may underestimate the number of people with the disease by a factor of four to five. Meaning that between 62 million and 78 million individuals worldwide may currently have RHD, which could potentially result in 1.4 million deaths per year from RHD and its complications.(ii)

More Support Needed for RHD Programs

When RHD was controlled in wealthy countries during the second half of the 20th century it was dropped from many congress agendas, largely removed from medical school curricula and research funding significantly reduced. As a result, research, prevention and control is under-funded. But new leaders are emerging from within the medical communities of countries most affected by this disease.

A group in South Africa, led by Dr. Bongani Mayosi (Groote Schuur Hospital and University of Cape Town, South Africa), has established an initiative in 10 African countries - the Awareness Surveillance Advocacy Prevention (ASAP) program - that aims to help reduce the burden of RHD and contribute to eliminating rheumatic fever.

"RHD is a serious health problem in Sub-Saharan countries and it became clear that we needed to do something ourselves to try to eradicate this disease," said Dr. Mayosi. "Through the ASAP initiative we have mobilized researchers and health advocates from around the continent to get an accurate understanding of RHD prevalence, the natural history of the disease and current medical practice to develop a comprehensive approach that works in Africa.

The World Heart Federation has emerged as the leader of global efforts to control RHD and supports the ASAP initiative. "In many of the world's poorest countries RHD is the major cause of acquired heart disease," remarked Johanna Ralston. "The World Heart Federation is committed to working with doctors, patients and other organizations to build commitment for the prevention and control of this disease."

Contact Profile


RHD is a chronic heart condition caused by rheumatic fever. Rheumatic fever is, in turn, an inflammatory disease caused by a preceding group A streptococcal (strep) infection. RHD is a substantial global health problem that can result in irreversible heart damage and death. It occurs predominately in developing countries and is also common in poorer populations in middle-income countries (e.g. Brazil, India) and some indigenous populations in wealthy countries (Australia, New Zealand). RHD will continue to be a global problem unless current prevention initiatives are expanded and sustained.

RHD can be Prevented and Controlled

Treating strep throat with antibiotics can prevent rheumatic fever. Regular antibiotics (usually monthly injections) can prevent patients with rheumatic fever from contracting further strep infections and causing progression of valve damage. The antibiotic (benzathine penicillin G) most often used is off-patent and can be administered through basic primary care for just cents.

About the World Heart Federation

The World Heart Federation is dedicated to leading the global fight against heart disease and stroke with a focus on low- and middle-income countries via a united community of more than 200 member organizations. With its members, the World Heart Federation works to build global commitment to addressing cardiovascular health at the policy level, generates and exchanges ideas, shares best practice, advances scientific knowledge and promotes knowledge transfer to tackle cardiovascular disease - the world's number one killer. It is a growing membership organization that brings together the strength of medical societies and heart foundations from more than 100 countries. Through our collective efforts we can help people all over the world to lead longer and better heart-healthy lives.

(i) Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5:685- 694.

(ii) Paar JA, Berrios NM, Rose JD et al. Prevalence of Rheumatic Heart Disease in Children and Young Adults in Nicaragua. Am J Cardiol 2010;105:1809 -1814.
Charanjit Jagait
P: +41 22 807 0334


Urgent Action Needed Stop Rheumatic Heart Disease From Killing Disabling People Bottom Billion



More Formats