Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review

Bennett, Julie; Rentta, Neilenuo Nelly; Leung, William; Atkinson, June; Wilson, Nigel; Webb, Rachel; Baker, Michael G

doi:10.1111/jpc.15664

Cited by 4 publications

(3 citation statements)

References 61 publications

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“…Several studies have focused on the cost of echocardiographic screening. 63 - 65 In a study in New Zealand, the cost of echocardiographic screening was 60-230 NZD per patient screened. 65 To successfully implement screening programs, health policies should be developed together with the public, and sufficient funds should be allocated.…”

Section: Implementation and Cost Of Echocardiographic Screening For R...mentioning

confidence: 99%

Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges

Topçu,

Uçar

2024

Turkish Archives of Pediatrics

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The incidence of acute rheumatic fever (ARF), which most commonly affects children aged 5-15 years after group A Streptococcus (GAS) infection, ranges from 8 to 51 per 100 000 people worldwide. Rheumatic heart disease (RHD), which occurs when patients with ARF are inappropriately treated or not given regular prophylaxis, is the most common cause of non-congenital heart disease in children and young adults in low-income countries. Timely treatment of GAS infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is a key aspect of RHD control. The most important factor determining the prognosis of RHD is the severity of cardiac involvement. Although approximately 70% of patients with carditis in the acute phase of the disease recover without sequelae, carditis is important because it is the only complication of ARF that causes sequelae. One-third of patients with ARF are asymptomatic. Patients with mild symptoms of recurrent ARF and silent RHD will develop severe morbidities within 5-10 years if they do not receive secondary preventive treatments. A new screening program should be established to prevent cardiac morbidities of ARF in moderate- and high-risk populations. In the present study, we examined the applicability of echocardiographic screening programs for RHD.

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Section: Implementation and Cost Of Echocardiographic Screening For R...mentioning

confidence: 99%

Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges

Topçu,

Uçar

2024

Turkish Archives of Pediatrics

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“…It is estimated that over 500,000 deaths annually are attributable to GAS infection, with a significant effect on disability-adjusted life years (DALYs), particularly in low-and middle-income countries (LMICs) [1]. The burden is highest in LMICs where genetic predisposition and poor access to both screening and antibiotic treatments are commonly cited as contributing factors [2,3]. For example, in New Zealand, those of Māori and Pacific Island descent have increased risk of rheumatic heart disease (RHD), with independent contributions to this risk from ethnicity, socioeconomic deprivation and their geographic location [4].…”

Section: Introductionmentioning

confidence: 99%

Mucosal Immunization Has Benefits over Traditional Subcutaneous Immunization with Group A Streptococcus Antigens in a Pilot Study in a Mouse Model

Shaw,

Remmington,

McKenzie

et al. 2023

Vaccines

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Group A Streptococcus (GAS) is a major human pathogen for which there is no licensed vaccine. To protect against infection, a strong systemic and mucosal immune response is likely to be necessary to prevent initial colonization and any events that might lead to invasive disease. A broad immune response will be necessary to target the varied GAS serotypes and disease presentations. To this end, we designed a representative panel of recombinant proteins to cover the stages of GAS infection and investigated whether mucosal and systemic immunity could be stimulated by these protein antigens. We immunized mice sublingually, intranasally and subcutaneously, then measured IgG and IgA antibody levels and functional activity through in vitro assays. Our results show that both sublingual and intranasal immunization in the presence of adjuvant induced both systemic IgG and mucosal IgA. Meanwhile, subcutaneous immunization generated only a serum IgG response. The antibodies mediated binding and killing of GAS cells and blocked binding of GAS to HaCaT cells, particularly following intranasal and subcutaneous immunizations. Further, antigen-specific assays revealed that immune sera inhibited cleavage of IL-8 by SpyCEP and IgG by Mac/IdeS. These results demonstrate that mucosal immunization can induce effective systemic and mucosal antibody responses. This finding warrants further investigation and optimization of humoral and cellular responses as a viable alternative to subcutaneous immunization for urgently needed GAS vaccines.

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“…5,6 Several reviews published over the last 10 years have explored interventions aimed at preventing or controlling RF, and assessed their effectiveness in the NZ context. [8][9][10][11] Despite the significant burden of acute RF and rheumatic heart disease among Pacific people, there is limited information regarding the breadth of interventions focused on, and led by this population.…”

Section: Introductionmentioning

confidence: 99%

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

Tu’akoi

Ofanoa²,

Ofanoa³

et al. 2022

J. Prim. Health Care

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Introduction. Rheumatic fever is a preventable illness caused by untreated Group A Streptococcus (GAS) infection. Despite reductions in most high-income countries, rheumatic fever rates remain a concern in Aotearoa New Zealand. Pacific and Māori people are inequitably affected, with risk of initial hospitalisation due to rheumatic fever 12-and 24-fold more likely, respectively, compared to non-Māori and non-Pacific people. Aim. This scoping review aims to explore the range of interventions and initiatives in New Zealand seeking to prevent GAS and rheumatic fever, with a particular focus on Pacific and Māori. Methods. Databases Scopus, Medline, EMBASE and CINAHL, along with grey literature sources, were searched to broadly identify interventions in New Zealand. Data were screened for eligibility and the final articles were charted into a stocktake table. Results. Fifty-eight studies were included, reporting 57 interventions. These targeted school-based throat swabbing, awareness and education, housing, secondary prophylaxis, improving primary care guidelines and diagnosis of sore throats and skin infections. Some interventions reported short-term outcomes of improvements in awareness, a reduction in rheumatic fever risk and fewer hospitalisations. Evaluation outcomes were, however, lacking for many initiatives. Pacific and Māori people primarily served only in an advisory or delivery capacity, rather than as partners in co-design or leadership from the beginning. Discussion. Although positive outcomes were reported for some interventions identified in this review, rheumatic fever rates have not shown any long-term reduction over time. Co-designing interventions with affected communities could ensure that strategies are better targeted and do not contribute to further stigma.

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Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review

Cited by 4 publications

References 61 publications

Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges

Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges

Mucosal Immunization Has Benefits over Traditional Subcutaneous Immunization with Group A Streptococcus Antigens in a Pilot Study in a Mouse Model

Addressing rheumatic fever inequities in Aotearoa New Zealand: a scoping review of prevention interventions

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