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Rheumatic heart disease (RHD) is a condition that affects more than 40 million people worldwide and it causes over 300,000 deaths annually. It is a chronic valvular heart disease caused by rheumatic fever, which develops after untreated Streptococcus pyogenes infection. RHD is a preventable condition. It can be prevented by early detection and diagnosis of this form of pharyngitis – acute rheumatic fever and heart disease – with antibiotic treatment of streptococcal pharyngitis and appropriate antibiotic prophylaxis for those who have experienced acute rheumatic fever.
Philips Foundation partnered with Heart Healers International in Uganda in a research trial to investigate the role of penicillin in early RHD management.
The trial (the GOAL Trial) was designed to determine the ability of intramuscular penicillin to modify the course of newly diagnosed latent RHD. Specifically, it was to determine the relative proportion of children (ages 5-17) who show echocardiographic progression and regression over 24 months and compared to those who were and were not assigned to receive intramuscular penicillin every four weeks.
As part of the Uganda Heart Institute‘s National Rheumatic Heart Disease Registry, supported by the Ugandan Ministry of Health, GOAL Trial affiliates conducted school-based heart disease screening using handheld echocardiogram (echo) machines at over 200 schools, including over 100,000 children. Severe cases of heart disease (>1%) were referred to the Gulu Regional Referral Hospital and were added to the national registry. Students with suspected cases of latent Rheumatic Heart Disease (RHD) (~3%) were referred to the GOAL Office for full echos, public health education, and for those who qualified, an invitation for GOAL Trial participation.
A total of 3 participants (0.8%) in the prophylaxis group had echocardiographic progression at two years, as compared with 33 (8.2%) in the control group (risk difference, −7.5 percentage points; 95% confidence interval, −10.2 to −4.7; P<0.001). Two participants in the prophylaxis group had serious adverse events that were attributable to the receipt of prophylaxis, including one episode of a mild anaphylactic reaction (representing <0.1% of all administered doses of prophylaxis).
The study concluded that secondary antibiotic prophylaxis among children and adolescents 5 to 17 years of age with latent rheumatic heart disease reduced the risk of disease progression at two years. Further research is needed before implementing population-level screening can be recommended. The next steps include testing a real-world model for RHD healthcare delivery that builds a foundation for national RHD action plans (as advised by the 2018 World Health Assembly RHD Resolution).
When 2018
Status Concluded
Where Uganda
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Project report
Resources
[1] Beaton et al. (2021). Secondary antibiotic prophylaxis for latent rheumatic Heart disease
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