NEPAL: Echocardiographic screening of children may reduce burden of rheumatic heart disease

Echocardiographic screening of children for subclinical rheumatic heart disease and secondary antibiotic prevention in affected children may reduce the burden in endemic regions, according to an abstract presented at Scientific Sessions.

In the study, researchers conducted a cluster-randomized comparison of echocardiographic screening for RHD versus a control group among schoolchildren in eastern Nepal:

  • Children in 19 schools were screened for subclinical RHD.
  • Those diagnosed with definite RHD received secondary antibiotic prevention and were prospectively followed in a registry.
  • After a mean follow-up of 4.3 years, 2,648 students from the screened schools and 1,325 children from the control schools underwent echocardiographic assessment.

In clinical and echocardiographic screenings of 178 children from 26 randomly selected schools, the prevalence of borderline or definite RHD was 10.2 per 1,000. Additionally, the prevalence of RHD increased with advancing age from 5.5 per 1,000 children at age 5 to 16.0 per 1,000 children at age 15.

“The trend toward a lower prevalence among the children at the screened schools resulted from remission of disease in children previously detected to have RHD and a lower incidence of new cases,” said Thomas Pilgrim, MD, professor of cardiology at Bern University Hospital in Bern, Switzerland.

Three of four children worldwide live in regions where rheumatic heart disease is endemic, Pilgrim said.

“Early stages of disease as observed among children and adolescents may be reversible,” he said. “It is, therefore, the age to catch RHD before serious damage occurs.” In a previous study, Pilgrim and colleagues demonstrated a high burden of RHD among children in eastern Nepal.

The rationale for the current study was twofold, Pilgrim said. “First, early detection of subclinical disease would allow for timely initiation of antibiotic prophylaxis with the potential of remission of disease. Second, effective antibiotic prophylaxis potentially contains the contagious pool and may reduce the incidence of new cases.”