While most heart disease worldwide affects adults, rheumatic heart disease is the one type of heart disease that affects mostly children and young adults in low-income countries. At least 33.4 million people worldwide are estimated to be currently affected by this type of heart disease. Rheumatic heart disease occurs when a group A streptococcal infection--also known as strep throat--is left untreated or is poorly treated and develops into rheumatic fever. Acute rheumatic fever can then cause fibrosis of heart valves (the thickening and scarring of connective tissues), which can lead to hindered blood flow in the heart, valvular heart disease, heart failure, and even death. Once you have rheumatic heart disease, treatment could entail expensive surgery to repair or replace damaged heart valves within the next 5 to 20 years.

While rheumatic fever has nearly disappeared from high-income countries (the United States is estimated to have 2 cases per 100,000 people), it continues to be responsible for about 233,000 deaths annually in lower income countries where about 100 cases occur per 100,000 people. This is because it is relatively simple to prevent the onset of rheumatic fever by using antibiotics (specifically, penicillin) to treat group A strep throat infections. The lack of availability of antibiotics as well as factors like overcrowding, poor housing conditions, undernutrition, and general lack of access to healthcare all contribute to the increased prevalence of rheumatic fever and, consequently, of rheumatic heart disease in low- and middle-income countries. Furthermore, there is little reliable global data on the prevalence of rheumatic fever and rheumatic heart disease, partially due to different screening strategies and clinical definitions of the disease. More research that better defines the burden of this disease will help future efforts to advocate for public health interventions.

The map above shows the areas of the world most burdened by rheumatic heart disease, with estimated prevalence. To learn more about rheumatic fever and how to prevent it, visit: www.RHDaction.org