Prophylaxis of Rheumatic Fever (RF) - Rheumatic Heart Disease (RHD)

Since the disease occurs primarily as a result of sore throat, through a specific group of organism i.e. group A streptococcus, therefore, prophylaxis of RF /RHD means prevention of sore throat. But the prevention of sore throat is not so simple as it may appear to be. There are a large number of cases of sore throat, and most of them are viral in nature, and out of the bacterial infection only a small number may be related to the specific organism i.e. group A streptococcus, responsible for RF /RHD. These specific organisms can only be identified if a throat swab is taken of each and every child for culture of the organisms. It may not be feasible in a disease like sore throat which is so commonly prevalent and subsides even without treatment in many of the cases, i.e., it is a self-limiting disease.

Due to the above reasons, it is not possible to detect the occult/hidden cases of sore throat as a result of group A streptococcus in a mass survey/check-up of children, as for example in various schools and colonies etc., because throat culture takes 48-72 hours, and there is no kit for quick detection of cases.

However, as a general prophylaxis sore throat should be immediately treated, irrespective of the causative organism, especially in children/adults for the prevention of RF /RHD. Doctors, especially pediatricians, can play a significant role in explaining to parents, especially mothers, for immediate treatment of sore throat in their children whenever it occurs. Teachers in schools also play an equally important role in this respect.

A long-term drug prophylaxis should be given to all children/ adults, who once suffered an attack of RF /RHD, for the protection of the throat against streptococcal infection. The duration of prophylaxis differs from case to case, as the incidence of the disease decreases as age advances. This drug prophylaxis may be given till the child reaches the adult age, or for five years after the last attack of RF /RHD. Once the prophylaxis is withdrawn, great vigilance is required, and the child/ adult should take proper treatment for sore throat as and when it occurs. However, drug prophylaxis may be required almost forever/lifelong, especially in cases which exhibit permanent signs of valvular /rheumatic heart disease. These damaged valves need foolproof protection against infection, and due to this reason, drug prophylaxis is given continuously. Long-acting antibiotics, like penicillin, is given in such cases every month; some advocate it every three weeks. In the case of children, the concerned parents must see to it that the child is strictly administered a regular course of antibiotic, as explained/motivated by their physician.

Also, all cases of RHO should take a short course of antibiotics (besides the long-acting antibiotics they are taking monthly) before undergoing any operative procedure, either minor or major, as for example dental extraction etc., as more virulent bacteria are likely to enter the blood from the area of operation leading to gross infection of the already damaged valves of the heart, called subacute bacterial endocarditic (SBE), which requires emergent measures to save the heart from damage. In that case strong antibiotics will be required to tide over the crisis.

As a part of prophylaxis, it is also important that the warning signals of rheumatic fever, must be known to all, especially parents/teachers and those at the rural level. The children should be immediately treated on the very first attack .of RF, and drug prophylaxis should be started without any delay.

Above all, since the disease occurs as a result of the infection of throat, proper hygienic conditions must be maintained for the prevention of sore throat / RF /RHO. This is the reason that people living in overcrowded/highly-populated, damp colonies/slums etc. become highly prone to this disease. Good food is also necessary for the prevention of this disease.

Summing up, it may be said that in order to achieve everlasting prevention, socio-economic factors as a whole, including especially the living conditions as well as the nutrition of the people, have to be improved, particularly among the lower strata of society. The people are required to be educated through various media regarding the dangerous consequences of ~ore throat, and that any sore throat must be treated promptly whenever it occurs. Of course, an early detection/treatment of cases which have already picked up the disease will be essentially required. For this all, we need a national strategy / programme, and only then we can hope to prevent this disease which is still one of the major health hazards in many developing countries. It is earnestly hoped that a streptococcal vaccine will soon be available, which may indeed prove to be a breakthrough in the prevention of this disease.

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