Epidemiology of rheumatic fever and rheumatic heart disease in a rural community in northern India

The epidemiology of rheumatic fever and rheumatic heart disease in a rural community (total population 114610) in northern India was studied by setting up a registry based on primary health care centres. Health workers and schoolteachers were trained to identify suspected patients in school and village surveys (121 villages). Medical specialists screened 5-15-year-olds (n = 31200). The population was followed up for 3 years (from March 1988 to March 1991). All suspected and registered cases were investigated by serial echocardiography and Doppler ultrasonography at a tertiary care centre. A total of 102 cases were confirmed to have rheumatic fever/rheumatic heart disease (prevalence, 0.09%); 66 were aged 5-15 years (prevalence, 0.21%). A total of 48 patients (24 males, 24 females; mean age, 12.11 ± 3.7 years) were diagnosed to have a possible first attack of rheumatic fever (incidence, 0.54 per 1000 per year). Arthritis was observed in 36 (75%) and carditis in 18 (37.5%) of cases. Prolapse of the anterior mitral leaflet into the left atrium occurred in 5 (22%) cases with carditis. Mitral regurgitation was observed in all 18 cases of carditis; over the period of observation it disappeared in three cases and progressed to mitral stenosis in a further three. A total of 22 patients (11 males, 11 females; mean age, 19.41 ± 8.1 years) were registered as rheumatic fever recurrences, and 32 patients (18 females, 14 males; mean age, 22.1 ± 10.1 years) had chronic rheumatic heart disease. Of those with recurrences, 9 (41%) had carditis and 11 (50%) had arthritis. No recurrences were observed among patients who complied with secondary prophylaxis with benzathine penicillin at 4-week intervals. Four patients with chronic rheumatic heart disease required mitral valvotomy and three required valve replacements. Eight patients (5 males, 3 females; mean age, 21.8 ± 8.8 years) died over the duration of the study period (3 with acute rheumatic fever, 3 from progressive heart failure, 1 from an adverse penicillin reaction, and 1 from a non-cardiac cause).