Present status of rheumatic fever and rheumatic heart disease in India.

This paper examines the present status of Rheumatic fever (RF) and Rheumatic heart disease (RHD) in India with reference to both prevalence and incidence, and evaluates the currently available methods of control. Data available over the last 10 years shows that the prevalence of RF/RHD in the most vulnerable group i.e. school children between 5 to 15 years of age is still unacceptably high. RHD is encountered in 1 to 5.4 per 1,000 in large samples of school children and RF in 0.3 to 0.5 per 1,000 children. There appears to be no obvious decline in its prevalence in school children over a 20 year period. Because of preoccupation with adult cardiac diseases specially ischemic heart disease (IHD), the problem of RF/RHD has been sidelined and studies on prevalence, treatment and prevention receive scant attention. Only exotic palliative methods such as balloon mitral valvotomy (BMV) have become the centre stage. Studies are needed on the lines of WHO recommendations for the regional prevalence of RF/RHD in school children throughout the country to detect regional variations. The most effective method for control is primary prevention by treating streptococcal sore throat and secondary prevention by early detection and continuous penicillin prophylaxis. This could be done most effectively by general physicians (GP's) who need motivation and education and through school health services. The latter needs to be organised on a state-wise basis throughout the country as it is available in only a few cities. Public health education by all available media specially, through video films is also recommended. The lacunae in our knowledge of RF/RHD calls for further research.