The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease

Abstract

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns around the world. Despite decreasing incidence, there is still a significant disease burden, especially in developing nations. This review provides background on the history of ARF, its pathology and treatment, and the current reported worldwide incidence of ARF and prevalence of RHD.

Keywords: epidemiology; group A streptococcus; rheumatic fever; rheumatic heart disease.

Figure 1

Electrocardiogram demonstrating first-degree heart block in a patient with acute rheumatic fever. The PR interval is noted by the arrows, and is markedly prolonged at 300 milliseconds (normal for an adult is less than 200 milliseconds).

Figure 2

a) Artist rendition of normal left heart anatomy, demonstrating the left atrium connected to the left ventricle via a mitral valve. b) Two-dimensional echocardiogram of the left heart, demonstrating a thickened anterior leaflet of the mitral valve. c) Two-dimensional echocardiogram with color Doppler, demonstrating moderate-to-severe mitral valve regurgitation (blue jet).

Figure 3

Schematic drawing of the M-protein structure with the conserved (blue), variable (red), and hypervariable (green) regions. Note that the conserved region is closest to the cell membrane.

Figure 4

Map showing reported worldwide incidence of ARF from 1970 through 1990.,,– (1) Barbados,, (2) Fiji, (3) French Antilles, (4) French Polynesia, (5) Federated States of Micronesia, (6) Israel, (7) Kuwait,– (8) New Caledonia, (9) Northern Mariana Islands, (10) Samoa, (11) Tonga,, (12) Trinidad, (13) Alabama, (14) Arizona, (15) California,, (16) Florida, (17) Hawaii,– (18) Minnesota, (19) Mississippi, (20) Navajo Reservation, (21) Ohio,,(22) Rhode Island, (23) Tennessee, (24)Utah, (25) Virginia, (26) West Virginia,, (27) Wyoming.

Figure 5

Map showing reported worldwide incidence of ARF from 1991 through present., , , , , , – (1) American Samoa,, (2) Fiji,– (3) Grenada, (4) Israel,, (5) Jordan, (6) Kosrae, Federated States of Micronesia, (7) Lebanon, (8) New Caledonia, (9) Northern Mariana Islands, (10) Qatar, (11) West Virginia.

Figure 6

Map showing reported worldwide prevalence of RHD from 1970 through 1990.,,,,,–,,,,,,,– (1) Barbados, (2) Cook Islands, (3) El Salvador, (4) Fiji, (5) French Polynesia, (6) Jamaica, (7) Puerto Rico, (8) Samoa, (9) Tonga,, (10) Minnesota.

Figure 7

Map showing reported worldwide prevalence of RHD from 1991 through present.–,,,,,,,,,,,,– (1) Fiji,, (2) Samoa, (3) Tonga.

Figure 8

Trends of acute rheumatic fever incidence per 100,000 persons for each WHO region, A) The Americas, B) Europe, C) Africa, D) Eastern Mediterranean, E) Western Pacific, and F) Southeast Asia. Points represent reported incidence from the literature.

Figure 9

Trends of rheumatic heart disease prevalence per 1000 persons for each WHO region, A) The Americas, B) Europe, C) Africa, D) Eastern Mediterranean, E) Western Pacific, and F) Southeast Asia. Points represent reported prevalence from the literature.

Figure 10

Number of reported occurrences of each streptococcal M-type in A) developing nations, B) developed nations, and C) both combined. Note: *denotes M-types contained in 26-valent GABHS vaccine. Abbreviation: NT, nontypeable.