Screening of asymptomatic rheumatic heart disease among refugee/migrant children and youths in Italy

Abstract

Background Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population. Methods From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. ‘Definite’ and ‘borderline’ cases were defined according to the World Hearth Federation criteria. Results Six hundred fifty-three individuals (13–26 years old) were screened; 95.6% were below 18 years old (624/653). Six ‘definite RHD’ were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1–20.3‰), while 285 (436.4‰) were defined as ‘borderline’ (95% CI 398.8–474.9‰). Out of 172 “non-negative borderline” cases available for being retested (113 “non-negative borderline” lost in follow-up), additional 11 were categorized as ‘definite RHD’, for a total of 17 ‘definite RHD’, yielding a final prevalence of 26.0‰ (95% CI 16.2–41.5‰) (17/653), and 122 (122/653) were confirmed as ‘borderline’ (final prevalence of 186.8‰, 95% CI 158.7–218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both ‘borderline’ (OR 4.3 [2.8–6.5]) and ‘definite RHD’ (OR 5.2 [1.7–15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD. Conclusions Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of ‘definite RHD’ was similar to that identified in resource-poor settings, while the prevalence of ‘borderline’ cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children.

Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management

“…Moreover, RHD has been reported in middle‐class children in Utah, United States of America, 7‐9 and outbreaks have been recently reported in Trieste, Italy 10 . More recently, in a study done by Condemi et al 11 in Italy, it was found that the prevalence of RHD was similar to that found in resource‐limited countries. Indeed, Marijon 12 warned that ‘the affluent world cannot afford complacency; large population movements and refugee crises can displace persons with RHD to developed nations’.…”

“…The prevalence of subclinical RHD was 2.1% similar to that found in other parts of the world 13 such as India (2.0%), Cambodia (2.2%) and Mozambique (3%). Similarly, Condemi et al 11 have recently screened refugees aged 13-26 years and found a prevalence of 'definitive RHD' of 2.6% while that of 'borderline RHD' was 18.6%. The burden of borderline cases was markedly higher than that reported elsewhere.…”

Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia?

“…Most of the RHD screening programs utilized portable echocardiography for more comfortable mobility in remote areas, and in general, they showed a reasonable value for RHD screening. Many studies reported the prevalence of RHD and RHD screening, mainly in regions with a high prevalence of RHD, including Uganda ( 24 , 25 ), Sudan ( 26 ), South Africa ( 27 ), Ethiopia ( 27 ), Italy ( 28 ), Brazil ( 29 ), Egypt ( 30 ), and Fiji ( 31 ). In general, these studies utilized standard portable echocardiography or handheld machines with simplified criteria for on-site screening.…”

Prevalence and Predictors of Rheumatic Heart Disease among School Children in Mansoura District, Egypt

“…It is a major cause of heart failure among children and young adults leading to disabilities and premature deaths. 1 The prevalence of RHD varied greatly between countries and even between different ethnic groups within the same country during the last 10 years of the last century in developing countries, the large number of cardiac surgical procedures is due to RHD which constitute a significant burden on the individual, the family and the community at large and a drain of the economy. 2 Currently, the yearly incidence varied from < 0.5/100 000 in high income countries to > 100/100 000 in poor countries.…”

“…Currently, RHD is still the leading aetiology of heart-related mortalities in poor nations. 1 Early detection of subclinical RHD is essential in order to detect cases at a time when penicillin has the ability to prevent progression to valvular disease in early adult life. 6 There is increased utilization of portable echocardiography for screening of RHD.…”