Rheumatic fever and rheumatic heart disease - report of a WHO Expert Consultation

WHO technical report series 923

Introduction

A WHO Expert Consultation on Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD) met in WHO/HQ, Geneva from 29 October to 1 November 2001 to update the WHO Technical Report 764 on Rheumatic Fever and Rheumatic Heart Disease, first published in 1988 (1).

RF and RHD remain significant causes of cardiovascular diseases in the world today. Despite a documented decrease in the incidence of acute RF and a similar documented decrease in the prevalence of RHD in industrialized countries during the past five decades, these non-suppurative cardiovascular sequel of group A streptococcal pharyngitis remain medical and public health problems in both industrialized and industrializing countries even at the beginning of the 21st century. The most devastating effects are on children and young adults in their most productive years.

For at least five decades this unique non-suppurative sequel to group A streptococcal infections has been a concern of the World Health Organization and its member countries. Sentinel studies conducted under the auspices of the WHO during the last four decades clearly documented that the control of the preceding infections and their sequelae is both cost effective and inexpensive. Without doubt, appropriate public health control programs and optimal medical care reduce the burden of disease (1–6).

Although the responsible pathogenic mechanism(s) still remain incompletely defined, methods for optimal prevention and management have changed during the past fifteen years (5–8). To make this information available to physicians and public health authorities, WHO convened this expert consultation to both update and to expand the 1988 document. RF and RHD remain to be conquered, but until that can be accomplished, optimal methods of prevention and management are required. The recommendations in this document are based upon current medical literature. Every attempt has been made to make this a practically useful document and at the same time to furnish appropriate references with additional information for the practitioner.

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References and related links

3. Strasser T et al. The community control of rheumatic fever and rheumatic heart disease: report of a WHO international cooperative project. Bulletin of the World Health Organization, 1981, 59(2):285–294.

4. WHO/CVD unit and principal investigators. WHO programme for the prevention of rheumatic fever/rheumatic heart disease in sixteen developing countries: report from Phase I (1986–1990). Bulletin of the World Health Organization, 1992, 70(2):213–218.

7. Narula J et al. Rheumatic fever. Washington, DC, American Registry of Pathology Publisher, 1999.

8. Stevens D, Kaplan E. Streptococcal infections. Clinical aspects, microbiology, and molecular pathogenesis. New York, Oxford University Press, 2000.