Strep A & Rheumatic heart disease
Despite being a 100% preventable disease, rheumatic heart disease (RHD) remains prevalent across the globe due to inequities faced by underprivileged communities. But what exactly is RHD? What has Strep A got to do with it? How do we diagnose and treat it? Find answers to these questions and more right on this page.
What is RHD?
Rheumatic heart disease is a permanent form of heart damage, caused by an abnormal reaction to infection by the Group A Streptococcus pyogenes bacterium (Strep A)- and it’s only one among the many dangerous conditions caused by this bug. Young Indigenous Australians aged 5-15 are the most at-risk to develop RHD.
The path to RHD begins with a sore throat or skin infection caused by Strep A. If not treated with antibiotics, some young people will go on to develop acute rheumatic fever (ARF) some weeks later.
Acute rheumatic fever (ARF) causes sore joints, high fevers, and inflammation of the heart. While the other symptoms of acute rheumatic fever pass after time, the heart damage remains.
Repeated damage from ARF can lead to permanent heart damage, known as rheumatic heart disease (RHD).
Diagnosis and management
It’s important to note that there is no cure for rheumatic heart disease, although the path towards the disease can be interrupted at different times. The best way to fight RHD is to combat the factors that cause it in the first place, as once an individual has the disease, treatment of symptoms is often invasive and long-term.
1. Primordial prevention
Ideally, we would reduce the amount of Strep A that people are exposed to – by reducing household crowding and making living environments healthier and cleaner. This is called concentrating on the social determinants of health (sometimes called primordial prevention).
2. Primary prevention
In the early stages, Strep A infections can be diagnosed and treated, preventing the development of acute rheumatic fever and RHD. This is called primary prevention.
3. Secondary prevention
Once someone has developed ARF or early RHD, they can be given regular antibiotic injections to stop further Strep A throat or skin infections, and prevent heart valve damage getting worse. This means a young person diagnosed with ARF needs an injection every 21 to 28 days for at least ten years. This is called secondary prevention.
4. Disease management
Without this treatment, people with RHD may end up with heart failure, needing heart surgery. Surgery does not cure RHD and people living with advanced RHD need a lifetime of medical care and follow up.
Tragically, many Aboriginal and Torres Strait Islander Australians die of the disease in their 40s.
Why are Aboriginal and Torres Strait Islander people at such high risk of Strep A Infection?
Aboriginal and Torres Strait Islander Australians live with some of the highest rates of Strep A infection, ARF and RHD in the world – caused by very high exposure to Strep A in young children.
Infection with this germ occurs frequently in crowded living environments, and houses with inadequate health hygiene facilities. Diagnosis and treatment of these frequent infections is difficult for many Aboriginal and Torres Strait Islander people who face practical, economic and cultural barriers to accessing health care.
Poverty and inequality may also contribute to the high rates of RHD. Genetic studies in Australia and internationally have not shown that Indigenous people are inherently more susceptible to the disease, although individuals in any population are genetically more likely than others to develop rheumatic fever or rheumatic heart disease. Around the world, economic development, improved living conditions and access to health care have reduced the rate of rheumatic fever in communities which previously had a high rate of the disease.
For this reason, RHD can be considered a disease of social disadvantage which can be reduced by improving the social and economic environments where people live, learn and work.
Aboriginal and Torres Strait Islander people are currently living with RHD & ARF
- A further 8,667 Aboriginal and Torres Strait Islander children are predicted to develop RHD & ARF by 2031 100%
- 1,356 of them will need heart surgery 15.65%
- 663 of them with RHD will die 7.65%
Strep A & RHD Stories
The consequences of Strep A infections and rheumatic heart disease aren’t limited to those living with the disease, they can be debilitating for families and even impact entire communities. These are their stories of courage, persistence and hope.
Isla’s story
Adele’s story
Tenaya’s story
Laqueisha’s story
All illustrations credited to Kimberley Aboriginal Medical Services Ltd (KAMS)