ARF and RHD are preventable diseases

RHD is a preventable and treatable disease. It is common in low- and middle-income countries (Wyber 2014, Webb, 2015), and only in socioeconomically disadvantaged populations in high-income countries. Both ARF and RHD are linked with overcrowding, socioeconomic deprivation, low levels of functioning “health hardware” (for example toilets, showers, taps etc.) and lack of access to health care services (Webb, 2015, Sims et al 2016). Prevention measures that improve the living and environmental health conditions to the extent that ARF and RHD are no longer common in affected communities are known as primordial prevention measures. Improved living conditions and access to functional health hardware can reduce high rates of Group A streptococcal infections and high rates of progression to ARF (Katzenellenbogen et al, 2017). 

After a group A streptococcus (GAS) infection, progression to ARF is preventable through early treatment. This is called primary prevention of ARF and relies on correct diagnosis and treatment within 9 days of onset of GAS throat infection (Gerber et al, 2009).  People not seeking medical attention for a throat infection, or misdiagnosis can affect timeliness of treatment, as well as failure to prescribe treatment as recommended in clinical guidelines (RHD Australia, 2012).

Secondary prevention of the progression from ARF to RHD relies on correct diagnosis of ARF, to enable commencement of regular antibiotic preventive medication. Correct diagnosis is challenging as there is no specific laboratory test for ARF. Diagnosis is based on clinical criteria outlined in the Australian modification of the Jones criteria (Appendix A), which takes into account Australia’s high-risk groups, particularly Aboriginal and/or Torres Islander people (Carapetis et al, 2016). Guidelines recommend admission to hospital for clinical investigation and confirmation of the diagnosis (RHD Australia 2012).

For people with suspected or clinically confirmed ARF episodes, benzathine penicillin G (BPG) is recommended in order to prevent further GAS infections and thereby reduce the risk of developing RHD or of RHD progression (Stollerman et al, 1955). BPG prophylaxis is clinically effective and cost-effective for RHD control at both individual and community levels (Webb, 2015, Wyber, 2015 and RHD Australia 2012).