Rheumatic heart disease is a vastly under-researched condition that disproportionately affects low-income countries, with an estimated 55 million cases worldwide. It is the leading cause of cardiac-related mortality in children globally, particularly impacting those aged 5-15 years, typically in kindergarten and lower primary school.
The disease progresses through three stages: an initial strep throat infection, an infectious disease; followed by acute rheumatic fever, an inflammatory disease; and culminating in rheumatic heart disease, a severe heart condition. Early detection is crucial, as the disease can be prevented or even reversed through secondary antibiotic prophylaxis for latent heart disease.
Dr. Emmy Okello, MD Chief of Cardiology at the Uganda Heart Institute and Co-Principal Investigator of the “Gwoko Adunu pa Lutino” (GOAL) study, which translates to “protect the heart of a child.”
Why study this topic?
Rheumatic heart disease is the most common heart disease in Africa, particularly among young people. When we examine the disease burden in Africa, hypertension ranks as the top concern (causing over 500,000 deaths annually and resulting in 10 million lives lost
over the last decade), followed by rheumatic heart disease. Uganda also remains endemic for Rheumatic Heart Disease (RHD), affecting an estimated 300,000 schoolchildren.) However, if we focus specifically on individuals under 25 years old, rheumatic heart disease emerges as the leading cause of heart disease. This prevalence among young people, especially those aged 5 to 25, is why I chose to study rheumatic heart disease.
What did you find?
We found that there’s a stage among children and adolescents aged 5 to 17 years when the disease is quiet, known as latent rheumatic heart disease or silent rheumatic heart disease. This stage can be reversed. You can do that by going to a school and screening children who are running around with no symptoms and randomly using echocardiograms (echo). The echo will identify those who have early changes, meaning they had the first symptoms—sore throat, rheumatic fever—and the heart has started to change, but no one knows. Secondary antibiotic prophylaxis has been shown to reduce the risk of disease progression at 2 years.
What would you like to see happen based on the study’s results?
What I want to see long-term is a reduction in prevalence. We don’t want a child born today to die of rheumatic heart disease because we have done a lot of work. We know what causes it. We need to work with the government for some aspects that are beyond our control, like improving the standard of living, ensuring people are not overcrowded and have proper living conditions. But from a scientific point of view, we know how the disease spreads. If you give children penicillin, you can prevent progression.
Then I will be very happy because we would have contributed to the reduction in the deaths from rheumatic heart disease. When you walk around the Uganda Heart Institute, you see some patients who cannot afford the surgery, some can but they come in when it is too late.
New England Journal of Medicine, Jan, 2022
