PREVENTION OF RHEUMATIC FEVER

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PREVENTION OF RHEUMATIC FEVER

• Dr. Animesh Mishra, DM (Delhi University)
• Associate Professor
• Department of Cardiology
• NEIGRIHMS
• Shillong-12

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What is Acute Rheumatic fever ?

• Infectious
• Immunological
• Genetic
• Collagen Vascular Disease
• Or an unidentified factor.

?
3
Is It Possible to Prevent Rheumatic Fever ?

• Primordial Prevention
• Primary Prevention
• Secondary Prevention

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Primordial prevention

• Preventing the development of risk factors
• Measures for Primordial Prevention
• 1- Improvement in Socio-Economic Status
• 2- Prevention of overcrowding
• 3- Availability of Prompt Medical care
• 4- Public Education

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Primary Prevention

• Measures for Primary Prevention
• Identification (GAS)
• Eradication (Penicillin)
• Susceptible individuals ?
• Anti Streptococcal Vaccine
• Theoretical possibility at the community
• but Possible at individual level

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Community level prevention Sledge Hammer
Approach

• 3-20 of sore throat are GAS
• .3 of GAS sore
  throat result in RF
• 90 of Patients of RF
  develops RHD
• 10000 Sore
  throats

10000
3-20 GAS
2000
300
.3 RF
1
6
.
90RHD
5
1
7
Identification and Eradication of GAS -Not
Feasible at community level

• 1- Asymptomatic sore throat
• 2- Diagnosis at mass level
• 3- Identification Methods not 100senstive and
  
• specific
• 4- Route of infection
• 5- Non compliance with the oral Treatment
• 6- Treatment failure (Penicillin failure)

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Susceptible individuals

• HLA-D 1,2,3,4
• HLA D 8/17 Indian population
• B cell alloantigen
• Results can not be utilized at community level

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Rheumatic Vaccine

• Strain specific M-Protein
• Caveats
• 1-Hundreds of Strains
• 2- Fast mutation rate
• 3- Virulent GAS may not
• produce M-Protein
• Polyvalent vaccines- Tried, but not
  successful

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• Conserved C-Terminus of M-protein
• C-5a Peptidase
• Fibro nectin surface binding Protein (sfb-1)
• Chemaric peptide J8
• Polysaccharide conjugated with protein

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• Health Education (5-16 years)
• Education by Parents
• Teachers
• All India Radio
• Doordarshan
• NICs, CICs

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• Health Education (5-16 years)
• Education by Parents
• Teachers
• All India Radio
• Doordarshan
• NICs, CICs

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Secondary PreventionSecondary Attack Rate -50

• Penicillin Prophylaxis Every 2-3 weeks
• (Depending upon the Age, Wt, Muscle
• mass )
• Duration of prophylaxis LIFE LONG
• 10Yrs/
  Adulthood
• 5Yrs/
  18Yrs.
• 1Yrs
• Anaphylactic Shock 1 1000000 105
• Secondary Prevention cannot reduce the burden of
  RHD
• SS