Strep A: A small bug with big consequences
The pathway to rheumatic heart disease starts with skin and throat infections of the Group A Streptococcus pyogenes bacterium, nicknamed Strep A, in early childhood. These can precipitate an abnormal immune reaction – acute rheumatic fever (ARF) – which leads to the scarring of the heart valves known as rheumatic heart disease (RHD).
Strep A infections can look like:
Sudden sore throat
Skin sores & rashes
Fast-developing fevers
Nausea & headache
Streptococccus pyogenes 3D image
WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease
World Health Organisation | Document
Preventing Rheumatic Fever and Rheumatic Heart Disease in the Community
World Health Organisation | Online course for primary healthcare workers & community health workers
From Patient to Advocate: Championing Safe Pregnancy with RHD
reach. | Article
Tackling NCDs: Best buys and other recommended interventions for the prevention and control of noncommunicable diseases
World Health Organisation | Document
Advocacy toolkit
Global Alliance for Rheumatic and Congenital Hearts & Children’s HeartLink | Document
The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022)
Menzies School for Health Research | Document
Global, Regional and National Advances Toward the Management of Rheumatic Heart Disease Based on the Global Burden of Disease Study 2019
Journal of the American Heart Association | Research article
Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015
Massachusetts Medical Society | Research article
RHD Action Report (2015-2020)
RHD Action | Document
Tools for Implementing RHD Control Programmes (TIPs) 2nd Ed.
We are currently adapting these for a Pacific context! RHD Action | Document
Global Status of BPG Report
RHD Action | Document
Rheumatic Heart Disease on the Health Report Podcast
ABC Radio National | Radio interview
World Heart Federation | Research article
Streptococcal Skin Infection and Rheumatic Fever
reach. | Document
The 2018 World Health Assembly Resolution on Rheumatic Fever and Rheumatic Heart Disease
World Health Assembly | Document
Journal of the American Heart Association | Research article
Open Forum Infectious Diseases | Research articles
Helpful resources
Below is a list of learning resources recommended by reach (one of the leading efforts to combat RHD on a global scale) and The Kids Research Institute Australia.
RHD can mean a lifetime of disability
Advanced RHD involves heart failure which causes breathlessness, fatigue and peripheral swelling. Those living with the disease might not be able to complete daily activities like housework, farming, and sports, or if the disease is more severe, they may not be able to wash or toilet independently.
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RHD has a disproportionate effect on women
RHD manifestation often overlaps with childbearing years, meaning women suffer from its impacts on pregnancy planning, stigma and obstetric complications
RHD has a disproportionate impact on economically marginalised people
Strep A infection risk is higher due to household crowding, inadequate health hygiene infrastructure and access to medical services.
Without treatment, people with RHD die in early to mid- adulthood.
Across the causal pathway of disease, RHD moves from a communicable disease of Strep A infections driven by environmental conditions to a chronic, non-communicable disease.
But treatment isn't easy to come by right now, involving monthly injections of penicillin to slow disease progression and, when heart valves are irreversibly damaged, open heart valve surgery. That's why we're working towards a future where Pacific patients have ready access to primary care service and coordination with international surgical teams, supported by robust medical records and RHD register systems.