The Heart and Stroke Foundation South Africa highlights Rheumatic Fever Prevention
According to the World Health Organization (WHO), rheumatic fever is an illness where the body's immune system overreacts to a throat or skin infection caused by a type of bacteria called Streptococcus pyogenes (Group A strep). This autoimmune inflammatory response can affect multiple organs including the heart, joints, and sometimes the skin and brain. This presentation is often seen between 10 to 21 days after the initial throat infection. RHD develops when multiple episodes of ARF occur, causing damage and scarring to heart valves and heart muscle.
According to the WHO (2023) technical brief on rheumatic fever and rheumatic heart disease, RHD affected an estimated 55 million people globally and caused 360,000 deaths in 2021. The WHO noted that the first episode of ARF is most commonly observed in children aged 5 to 14 years, followed by recurring infections within one year of the initial episode. These recurrences can persist throughout a person's life. The WHO also states that RHD typically begins in childhood, with the highest prevalence found in young adults aged 20 to 39 years. The report further highlighted that, internationally, women have a higher prevalence of RHD.
In the most recent National Institute for Communicable Diseases (NICD) GERMS-SA quarterly surveillance report (2025), an average of 824 cases of Group A Streptococcus infections were identified per year from 2021 to 2024 in South Africa. This figure may not accurately reflect the current situation in South Africa, as numerous cases remain undetected, undiagnosed, and uninvestigated. The RFW campaign aims to teach people about the dangers of ignoring or not treating throat infections caused by Group A Streptococcus. A study by Machipisa et al. (2021), published in JAMA Cardiology and focused on African countries, found that Black African people may be more likely to develop rheumatic fever (RF) and rheumatic heart disease (RHD) after being exposed to Group A Streptococcus—especially if there is a family history of the disease. This implies that extra care should be taken for individuals with a family history of RF and RHD. It's important to take steps to prevent disease, and even a simple sore throat should be treated right away. When rheumatic fever is diagnosed early, treatment can stop it from worsening. Doctors can give antibiotics to treat the infection and medicine to reduce pain and swelling. Regular check-ups and penicillin injections help prevent more attacks and protect the heart.
Recent research published in the
Egyptian Heart Journal
by Rifaie et al. (2020) on RF and RHD has shown promising results in identifying and treating these conditions. The inflammatory response, triggered by the Group A Streptococcus infection, may be chronic, meaning that the inflammation caused by the initial infection could persist for months after the infection is believed to have cleared. This suggests that the damage may continue if not treated appropriately. The authors emphasize that treating the inflammation is just as important as treating the bacteria causing the infection. This highlights why early check-ups and proper treatment are important, instead of trying to treat a sore throat on your own.
Prevention strategies are essential to reduce the return and spread of the infection. These include better hygiene, staying isolated when sick, improving living conditions, and increasing access to primary healthcare. Because RF can cause RHD through repeated episodes, ongoing community prevention is strongly advised. RHD is a serious heart condition that can lead to death or lifelong disability. It requires lifelong medication, regular medical check-ups, and often heart valve surgery.
RHD often damages the heart valves and surgical intervention is the primary treatment for replacing or repairing the damaged valve(s). Evidence from tertiary centers in South Africa, such as Chris Hani Baragwanath Hospital, suggests that early intervention can significantly improve outcomes for patients with RHD. However, in some low- and middle-income countries (LMICs), heart surgery facilities are often scarce, and long waiting periods can limit access to life-saving interventions, such as heart valve surgery. Necessary steps to improve specialized services at healthcare facilities to improve health outcomes for individuals living with RHD who require heart surgery. If the disease has become severe, the individual may also need to be treated for heart failure or an irregular heart rhythm. RHD can be prevented if ARF is treated promptly with the correct antibiotics, regular check-ups and prevention strategies are in place.
RHD remains a disease of poverty, disproportionately affecting LMICs and marginalized populations in high-income countries. Effective prevention and management of RHD require addressing the root causes of poverty, such as overcrowding, limited access to clean water and sanitation, and healthcare disparities. Ensuring adequate living conditions, equitable access to quality healthcare services, and implementing comprehensive prevention, screening, diagnosis, and treatment programs are essential to reducing the burden of RHD in vulnerable populations.
HSFSA leads the campaign annually, disseminating information and raising awareness about the relationship between RF and RHD. The Foundation encourages parents and caregivers to be more vigilant and actively work toward reducing the burden of RHD. The Foundation, along with our continental colleagues in Africa, strive to see a world without RF and RHD. Let us work together to make this a reality.For more information visit the Foundation's website:
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