Rheumatic Fever Week will be commemorated from Saturday 3 to Friday 9 August, to raise awareness of the harm fever can cause young children and individuals.
The week-long campaign brings attention to Rheumatic Fever (RF) as a serious autoimmune disease that affects various parts of a child’s body, including the joints, heart, skin, nervous system and the brain. It occurs when a child’s immune system overreacts to an untreated strep throat.
RF affects up to 40 million people living in low-income countries and globally, claiming more than 300 000 lives each year. Sub-Saharan Africa remains the region with the highest prevalence of Rheumatic Heart Disease (RHD) in the world, causing about 18 000 deaths annually (Lancet Global Health, May 2021).
The incidence of Acute Rheumatic Fever (ARF) is eight to 51 per 100 000 people worldwide. RF, however, rarely occurs in countries with more resources available and mostly affects children, adolescents and pregnant women in low-and middle-income countries, especially where poverty is widespread and access to health services is limited.
What is RF?
RF is an abnormal immune reaction to a common bacterium called Group A Streptococcus and is preceded two or three weeks earlier by a bacterial throat infection, commonly called “strep throat”.
Streptococcal infections are most common in childhood and it usually appears in children between age 5 and 15. However, adults and young children can still contract the illness.
In some people, repeated streptococcal infections 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.
RF patients typically experience a range of symptoms that can include joint pain, fever above 38°C, generally feeling unwell, shortness of breath, a skin rash, heart murmur and, on rare occasions, uncontrolled body movements.
People who live in overcrowded and poor conditions, and those aged 5 to 15 are at greatest risk of developing the disease.
RF was made a notifiable condition in South Africa in 1989, and the national Department of Health declared the first week of August National Rheumatic Fever Week, to highlight the need to implement proven interventions to reduce the incidence of ARF and the prevalence of RHD in a middle-income country such as South Africa, a country with high levels of inequality despite such income levels.
Cardiac involvement during ARF can result in RHD if left untreated. RHD results from the inflammation and scarring of heart valves caused by RF.
Symptoms of heart-valve damage that are associated with RHD may include chest pain or discomfort; swelling of the stomach, hands or feet; shortness of breath; fatigue and rapid or irregular heart beat. If RHD is left untreated, RHD will eventually lead to further heart valve damage, stroke, heart failure, and even premature death. The disease requires life-long medication, medical surveillance and often heart valve replacement surgery.
Significantly, however, RF can be completely prevented by the oldest antibiotic available, namely, penicillin. Key to this preventive step is an early diagnosis. While scientific advances and ongoing research are steps in the right direction, it takes time for findings to be put into practice.
Continued prevention efforts at the community level are therefore very much recommended. These could be focused on raising community awareness of Group A streptococcal throat infections and the link with RF and RHD.
Likewise, improving living conditions, hygiene and access to primary health care should continue to be prioritised. Preventing subsequent streptococcal infections is crucial once RF has been diagnosed in a patient, as this may result in another episode of RF and more damage to the heart valves.
The patient should be treated with antibiotics for an extended period of time in order to prevent further streptococcal infection.
Moreover, both advocates and those affected by RF and RHD need to mobilise and constructively work together to ensure the correct access to essential care for RF and RHD, particularly in the public sector.
Practical ways to prevent infection in children:
- Parents, school teachers and other caregivers can make a difference by simply looking out for a sore throat, and by educating children about what precautions to take. A sore throat in the absence of a cold or flu could possibly be a strep throat, which can cause RF.
- A child with a sore throat and suspected strep throat should stay away from school to avoid spreading the infection to other children.
- The child should be taken to the doctor or clinic if a strep throat is suspected.
- Teach children good hygiene, including hand washing, to prevent the spread of germs.
Other key points in adults and children, are keeping the immune system strong, by:
- consistent sleep (seven to nine hours per night);
- good hygiene such as hand washing;
- exercise (150 minutes of moderate-intensity per week);
- eat healthy (including all food groups: unrefined starches, lean proteins, good fats and variety of fruits and vegetables);
- avoid people who are sick; and
- manage stress (stick to routines for children).
Moreover, the Heart and Stroke Foundation South Africa has annually played an important role in disseminating information and knowledge regarding the relationship between RF and RHD. It conveys a consistently empowering message to parents and caregivers that RHD is to a large extent preventable.
Said foundation CEO Prof Pamela Naidoo: “The organisation plays an important role in education and knowledge dissemination for RF, RHD, as well heart disease in general.”
She urged parents and care-givers to take the responsibility to ensure that your child receives medical care, particularly for very high fever and a fever that does not “settle”.
Contact the foundation for more information and to also work with us to reduce the RHD burden. Also, use the health chat line that is ably run by the foundation’s health professionals, headed by Juandre Watson and Shonisani Nephalama.
- For more information, visit www.heartfoundation.co.za.
