Streptococcal pharyngitis, rheumatic fever and rheumatic heart disease: Eight-year prospective surveillance in Rupnagar district of Punjab, India.
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Date
2014-03
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Abstract
Background. Rheumatic fever (RF)/rheumatic heart disease
(RHD) continue to be a neglected public health priority. We
carried out a registry-based control project, prospective surveillance
and sample surveys to estimate the burden of disease.
Methods. We trained healthcare providers and established
a surveillance system for the 1.1 million population of Rupnagar
district in Punjab. In sample surveys conducted among schools,
physicians examined the sampled children. Children with a
cardiac murmur were investigated by echocardiography. Throat
swabs were obtained from a sub-sample, and group A streptococci
(GAS) were identified and emm typed by standard laboratory
methods. We estimated the morbidity rates for RF/RHD from
surveillance data and school surveys using a correction factor to
account for under-registration of cases in the registry.
Results. A total of 813 RF/RHD cases were registered from
2002 to 2009. Of the 203 RF and 610 RHD cases, respectively,
51.2% and 36.7% were males. In the age group of 5–14
years, RF was more common (80%) than RHD (27%). The
prevalence of RF/RHD in 5–14-year-old students was 1.0/
1000 (95% CI 0.8–1.3). The school survey indicated that
about two-thirds of the RF/RHD cases were enrolled in the
hospital-based registries. Based on the school survey, the prevalence of RF/RHD was estimated to be 143/100 000
population. In the registry, the annual incidence of acute RF was
estimated to be at least 8.7/100 000 children in the age group
of 5–14 years. The prevalence of GAS was 2% (13/656) in
children with sore throat and 0.5% (14/2920) among those
not having sore throat. Typing of 27 GAS revealed 16 emm
types. We estimate that about 1000 episodes of GAS pharyngitis
lead to one episode of acute RF.
Conclusion. RF/RHD continue to be a public health
problem in Punjab, India.
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KUMAR RAJESH, SHARMA YASH PAUL, THAKUR JARNAIL S, PATRO BINOD K, BHATIA ANJU, SINGH INDER P, RANA SAROJ KUMAR, CHAKRABORTI ANURADHA, DHANDA VANITA, SAPRU SUNITA, SHARMA MEENAKSHI, SHAH BELA, GANGULY NIRMAL K. Streptococcal pharyngitis, rheumatic fever and rheumatic heart disease: Eight-year prospective surveillance in Rupnagar district of Punjab, India. National Medical Journal of India. 2014 Mar-Apr ; 27 (2): 70-75.