India has highest rate of rheumatic heart disease in the world

Rheumatic heart disease affects – and kills – more people in India than anywhere else in the world. 119,000 people in India died from the condition in 2015, according to a study published earlier this year in The New England Journal of Medicine.

Just five countries account for 73 percent of all global cases of rheumatic heart disease, claim the study. A breakdown by country shows the number of cases of the condition in India were 13.17 million, followed by China with 7.07 million; Pakistan with 2.25 million; Indonesia with 1.18 million; and the Democratic Republic of the Congo with 805,000.

The number of cases of rheumatic heart disease have been falling in developed nations for the last 25 years. However, the number of cases have not significantly reduced in the vast majority of developing countries, where the condition is considered endemic. This can be attributed to lower access to treatments necessary to prevent streptococcal infections from causing long lasting damage.

The condition is the result of a previous infection of rheumatic fever, a streptococcal infection common in children between the ages of 5 and 15. Around 60 percent of people previously infected with rheumatic fever go on to develop some manner of heart condition. This is due to the infection causing damage to connective tissue. This can occur in the heart, joints, brain and skin.

The most commonly damaged tissue within the heart are the heart valves. Any damage to the heart resulting from rheumatic fever is referred to as rheumatic heart disease. Symptoms can include shortness of breath, heart palpitations and fatigue.

While rheumatic heart disease is not necessarily lethal of its own accord, antibiotics are constantly required as a recurrence of rheumatic fever is possible. This can result in infective bacterial endocarditis. This is a bacterial infection of the heart valves or lining of the heart and can be lethal.

Cost-effective interventions that treat streptococcal infection and prevent rheumatic fever and rheumatic heart disease from getting worse are abundant, but children often don’t have access to the care they need. This leads to the condition worsening and requiring advanced cardiac surgery (to repair or replace damaged heart valves) that may not be available in their country, claims David Watkins of the University of Washington School of Medicine.

Better data on the condition through national surveillance schemes is recommended by the study as one of the most effective ways of reducing mortality in the future. Through this, those previously infected by rheumatic fever could be monitored and medicated to prevent any future recurrence of the bacterial infection.