The Rheumatic Fever and Rheumatic Heart Disease Control programme--Jamaica

Abstract

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) are significant causes of World Health Organization (WHO) and International Society and Federation of Cardiology (ISFC) initiated an International Programme for Prevention of RF/RHD in 16 developing countries, including Jamaica. The Jamaican RF/RHD National Control Programme began in July 1985.

Subjects and method: The Control Programme promotes the primary prevention of RF/RHD through the appropriate treatment of streptococcal throat infections. Secondary prevention has been the main focus of the Control Programme by administration of benzathine penicillin injections every four weeks to RF/RHD patients. Case finding activities have included two retrospective surveys of case records of RF/RHD patients admitted to the major hospitals in Kingston and St Andrew in the period 1975-1985 (Survey A) and 1989-1995 (Survey B). These surveys provided clinical and laboratory data on RF/RHD in Jamaican patients which were documented and analysed.

Results: Records of 1079 patients were reviewed in Survey A and records of 512 patients were reviewed in Survey B. Seventy-seven per cent of 524 patients were aged 5-15 years in initial attacks of RF in Survey A and in Survey B, 82% of 119 patients were between 5 and 15 years in initial attacks. There was no significant sex difference in RF in Survey A and Survey B. A diagnosis of RF had been made in 54% of records in Survey A and 55% of records in Survey B. Diagnosis conformed to the Modified Jones criteria. Carditis occurred in 41% and 70% of RF patients, respectively in survey A and B. Polyarthritis occurred in 73% in Survey A and 74% in Survey B. Chorea occurred in 3% of RF patients in both surveys. Erythema marginatum and subcutaneous nodules occurred rarely in both surveys. Evidence of recent streptococcal infections in RF was found in 74% and 64% in Survey A and B, respectively. Severe carditis occurred in 7% of initial attacks of RF in A and 26% in B. In RHD, mitral incompetence was the commonest valvular lesion, occurring in 82% and 68% in A and B, respectively Rheumatic fever and rheumatic heart disease have relatively long and expensive hospital stays which are preventable by careful adherence to prevention programmes.

Conclusion: The National Control Programme for RF/RHD in Jamaica began in 1985 and deserves careful monitoring and support to reduce the burden of RF/RHD. Analysis of clinical and laboratory data obtained in the retrospective surveys conducted for case finding provides important data on RF/RHD in Jamaica.