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Scheel A, Miller KM, Beaton A, Katzenellenbogen J, Parks T, Cherian T, Van Beneden CA, Cannon JW, Moore HC, Bowen AC, Carapetis JR. Standardization of Epidemiological Surveillance of Rheumatic Heart Disease. Open Forum Infect Dis 2022; 9:S50-S56. [PMID: 36128407 PMCID: PMC9474940 DOI: 10.1093/ofid/ofac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Rheumatic heart disease (RHD) is a long-term sequela of acute rheumatic fever (ARF), which classically begins after an untreated or undertreated infection caused by Streptococcus pyogenes (Strep A). RHD develops after the heart valves are permanently damaged due to ARF. RHD remains a leading cause of morbidity and mortality in young adults in resource-limited and low- and middle-income countries. This article presents case definitions for latent, suspected, and clinical RHD for persons with and without a history of ARF, and details case classifications, including differentiating between definite or borderline according to the 2012 World Heart Federation echocardiographic diagnostic criteria. This article also covers considerations specific to RHD surveillance methodology, including discussions on echocardiographic screening, where and how to conduct active or passive surveillance (eg, early childhood centers/schools, households, primary healthcare), participant eligibility, and the surveillance population. Additional considerations for RHD surveillance, including implications for secondary prophylaxis and follow-up, RHD registers, community engagement, and the negative impact of surveillance, are addressed. Finally, the core elements of case report forms for RHD, monitoring and audit requirements, quality control and assurance, and the ethics of conducting surveillance are discussed.
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Affiliation(s)
- Amy Scheel
- Emory University School of Medicine , Atlanta, Georgia , USA
| | - Kate M Miller
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Andrea Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center , Cincinnati, Ohio , USA
- Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, Ohio , USA
| | - Judith Katzenellenbogen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- School of Population and Global Health, University of Western Australia , Nedlands, Western Australia , Australia
| | - Tom Parks
- Department of Infectious Disease, Imperial College London, Hammersmith Hospital , London , United Kingdom
| | | | - Chris A Van Beneden
- CDC Foundation, Centers for Disease Control and Prevention , Atlanta, Georgia , USA
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health , Boston, Massachusetts , USA
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Telethon Kids Institute, University of Western Australia , Nedlands, Western Australia , Australia
- Perth Children’s Hospital , Nedlands, Western Australia , Australia
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Longenecker CT, Morris SR, Aliku TO, Beaton A, Costa MA, Kamya MR, Kityo C, Lwabi P, Mirembe G, Nampijja D, Rwebembera J, Sable C, Salata RA, Scheel A, Simon DI, Ssinabulya I, Okello E. Rheumatic Heart Disease Treatment Cascade in Uganda. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.004037. [PMID: 29133472 DOI: 10.1161/circoutcomes.117.004037] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a leading cause of premature death and disability in low-income countries; however, few receive optimal benzathine penicillin G (BPG) therapy to prevent disease progression. We aimed to comprehensively describe the treatment cascade for RHD in Uganda to identify appropriate targets for intervention. METHODS AND RESULTS Using data from the Uganda RHD Registry (n=1504), we identified the proportion of patients in the following care categories: (1) diagnosed and alive as of June 1, 2016; (2) retained in care; (3) appropriately prescribed BPG; and (4) optimally adherent to BPG (>80% of prescribed doses). We used logistic regression to investigate factors associated with retention and optimal adherence. Overall, median (interquartile range) age was 23 (15-38) years, 69% were women, and 82% had clinical RHD. Median follow-up time was 2.4 (0.9-4.0) years. Retention in care was the most significant barrier to achieving optimal BPG adherence with only 56.9% (95% confidence interval, 54.1%-59.7%) of living subjects having attended clinic in the prior 56 weeks. Among those retained in care, however, we observed high rates of BPG prescription (91.6%; 95% confidence interval, 89.1%-93.5%) and optimal adherence (91.4%; 95% confidence interval, 88.7-93.5). Younger age, latent disease status, and access to care at a regional center were the strongest independent predictors of retention and optimal adherence. CONCLUSIONS Our study suggests that improving retention in care-possibly by decentralizing RHD services-would have the greatest impact on uptake of antibiotic prophylaxis among patients with RHD in Uganda.
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Affiliation(s)
- Chris T Longenecker
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Stephen R Morris
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Twalib O Aliku
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Andrea Beaton
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Marco A Costa
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Moses R Kamya
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Cissy Kityo
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Peter Lwabi
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Grace Mirembe
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Dorah Nampijja
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Joselyn Rwebembera
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Craig Sable
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Robert A Salata
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Amy Scheel
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Daniel I Simon
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Isaac Ssinabulya
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
| | - Emmy Okello
- From the Case Western Reserve University School of Medicine, Cleveland, OH (C.T.L., S.R.M., M.A.C., R.A.S., D.I.S.); Division of Cardiovascular Medicine (C.T.L., M.A.C., D.I.S.) and Department of Medicine, University Hospitals Cleveland Medical Center, OH (S.R.M., R.A.S.); Uganda Heart Institute, Kampala, Uganda (T.O.A., P.L., J.R., I.S., E.O.); Department of Pediatric Cardiology, Children's National Health System, Washington, DC (A.B., C.S., A.S.); Department of Medicine, Makerere University School of Medicine, Kampala, Uganda (M.R.K.); Joint Clinical Research Centre, Kampala, Uganda (C.K., G.M.); and Mbarara University of Science and Technology, Mbarara, Uganda (D.N.)
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