Acute Rheumatic Fever and Rheumatic Heart Disease Among Children — American Samoa, 2011–2012
Acute Rheumatic Fever and Rheumatic Heart Disease Among Children — American Samoa, 2011–2012
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发表时间：
2015-05
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通讯作者：
A. Beaudoin;Laura Edison;C. Introcaso;L. Goh;J. Marrone;A. Mejia;C. V. Van Beneden
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作者：
A. Beaudoin;Laura Edison;C. Introcaso;L. Goh;J. Marrone;A. Mejia;C. V. Van Beneden
急性风湿热是A组链球菌性咽炎（链球菌性咽喉炎）引起的非化脓性免疫介导的结果。复发性或严重的急性风湿热可导致永久性心脏瓣膜损伤和风湿性心脏病，这增加了心脏疾病的风险（例如，感染性心内膜炎、中风和充血性心力衰竭）。如果在症状出现后9天内使用抗生素，可以预防急性风湿热。长期注射苄星青霉素G（BPG）可有效预防复发性急性风湿热发作，建议每3-4周给药一次，持续10年或直到21岁，用于诊断为急性风湿热的儿童。2013年8月，针对急性风湿热和风湿性心脏病发病率上升的传闻报告，疾病预防控制中心与美属萨摩亚卫生部和林登B合作。约翰逊热带医学中心（美属萨摩亚唯一一家医院），以量化美属萨摩亚儿童急性风湿热和风湿性心脏病病例数，并评估咽炎漏诊、缺乏及时的预防处方和遵守规定的BPG预防的潜在作用。根据病历数据，2011年和2012年急性风湿热发病率分别为1.1例和1.5例/1,000名≤18岁儿童; 49%的急性风湿热患者随后被诊断为风湿性心脏病。65例患者中有22例（34%）在医生诊断为急性风湿热后未遵守推荐的BPG预防措施。2013年8月，风湿性心脏病患病率为每1,000名儿童3.2例。在美属萨摩亚建立一个协调的急性风湿热和风湿性心脏病控制计划，可能会改善诊断，治疗和患者对BPG预防的依从性。
Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis (strep throat). Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease, which increases the risk for cardiac conditions (e.g., infective endocarditis, stroke, and congestive heart failure). Antibiotics can prevent acute rheumatic fever if administered no more than 9 days after symptom onset. Long-term benzathine penicillin G (BPG) injections are effective in preventing recurrent acute rheumatic fever attacks and are recommended to be administered every 3-4 weeks for 10 years or until age 21 years to children who receive a diagnosis of acute rheumatic fever. During August 2013, in response to anecdotal reports of increasing rates of acute rheumatic fever and rheumatic heart disease, CDC collaborated with the American Samoa Department of Health and the Lyndon B. Johnson Tropical Medical Center (the only hospital in American Samoa) to quantify the number of cases of pediatric acute rheumatic fever and rheumatic heart disease in American Samoa and to assess the potential roles of missed pharyngitis diagnosis, lack of timely prophylaxis prescription, and compliance with prescribed BPG prophylaxis. Using data from medical records, acute rheumatic fever incidence was calculated as 1.1 and 1.5 cases per 1,000 children aged ≤18 years in 2011 and 2012, respectively; 49% of those with acute rheumatic fever subsequently received a diagnosis of rheumatic heart disease. Noncompliance with recommended prophylaxis with BPG after physician-diagnosed acute rheumatic fever was noted for 22 (34%) of 65 patients. Rheumatic heart disease point prevalence was 3.2 cases per 1,000 children in August 2013. Establishment of a coordinated acute rheumatic fever and rheumatic heart disease control program in American Samoa, likely would improve diagnosis, treatment, and patient compliance with BPG prophylaxis.