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Improved strategies needed to combat rheumatic fever resurgence in American Samoa children
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The incidence for acute rheumatic fever and the prevalence for rheumatic heart disease were high in American Samoa in August 2013 — the point prevalence for rheumatic heart disease was nearly 10 times that estimated for industrialized countries, according to data published in the Morbidity and Mortality Weekly Report.
“Efforts to improve pharyngitis diagnosis, treatment and compliance with penicillin prophylaxis might reduce the burden of acute rheumatic fever and rheumatic heart disease among children in American Samoa,” Amanda Beaudoin, DVM, PhD, a CDC epidemic intelligence service officer, and colleagues wrote. “These goals might be effectively met by establishment of a coordinated disease control program.”
In collaboration with the American Samoa Department of Health and the Lyndon B. Johnson Tropical Medical Center, the CDC sought to assess the number of pediatric acute rheumatic fever and rheumatic heart disease cases in American Samoa in August 2013. They additionally assessed the potential roles for missed pharyngitis diagnosis, lack of timely prophylaxis prescription and compliance with prescribed benzathine penicillin G prophylaxis.
The point prevalence for rheumatic heart disease was 3.2 cases per 1,000 children aged 18 years and younger in August 2013. The incidence for acute rheumatic fever was 1.1 cases per 1,000 children in 2011 vs. 1.5 cases in 2012.
Sixty percent of patients with acute rheumatic fever were male, with a median age of 11 years at diagnosis. Nearly half of acute rheumatic fever cases simultaneously received a diagnosis of rheumatic heart disease. Of 65 patients with physician-diagnosed acute rheumatic fever, 34% did not comply with recommended prophylaxis for benzathine penicillin G.
Although the annual incidence for acute rheumatic fever in the United States decreased to nearly 0.04 to 0.06 cases per 1,000 children during the late 20th century, there were exceptions to these low rates, including Samoan persons residing in Hawaii and residents of American Samoa, according to the researchers.
Rates for acute rheumatic fever in Hawaii were nearly 0.1 cases per 1,000 children — rates were even higher among those of Samoan and Hawaiian descent.
Disclosure: The researchers report no relevant financial disclosures.
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