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Rheumatic Heart Disease — a very serious problem in territory, says Dr. Parker

As part of Doctor’s Month 2014, the Department of Pediatrics at LBJ Tropical Medical Center is highlighting a very serious problem in American Samoa— Rheumatic Heart Disease (RHD), says Beth Parker, MD, who is with LBJ Pediatric Clinic.


The Doctors Month celebration this year is a milestone for the Lolo and Lemanu Administration, as this is the first time it has been commemorated in the territory.


RHD is the same topic Dr. Parker and Dr. Matt Tunoa will be discussing with the Senators today, before the Senate Health Committee.


According to Dr. Parker, RHD was common all over the world in the early 1900s, however it’s now “so rare in the mainland US that many doctors in training never encounter a patient with RHD.” She told Samoa News this is not the case in the territory— that while the prevalence of RHD among all Pacific nations was estimated at 3.5 per 1000 children in 2005, “today in American Samoa the rate is at least 9.2 per 1000 children.”


The doctor said that RHD is a very serious problem which can be prevented. She urged the public to join with the doctors and nurses at LBJ in spreading the word about improving hygiene, using insect repellant, and seeking prompt medical care for sore throats and skin infections.


“Families with children who have been diagnosed with acute rheumatic fever or RHD should be reminded to make sure they come in for their injections every three weeks. We are losing way too many talented children and young adults either to death or permanent disability from RHD,” she told Samoa News.


Parker noted that all doctors in the territory are familiar with the disease and the horrible complications it can cause. She said that in Pediatrics, they diagnose between three and five new cases of acute rheumatic fever (the disease which leads to RHD) each month, and are now following over 230 children who have had acute rheumatic fever — 60% of whom have developed heart disease.


"This all starts with exposure to a bacteria called “streptococcus”, she explained.  This exposure is commonly known as strep throat and any sore throat should be tested for strep.


As with the flu, chicken pox, pneumonia or any other illness, our bodies attempt to fight off the streptococcus bug via the immune system.  However, in rheumatic fever the immune system gets confused and the infection-fighters, or antibodies produced, attack not only the streptococcus bacteria, but also joints and heart valves.


Dr. Parker went on to say that with repeated exposure to streptococcus (which is inevitable in our tropical climate – there are bacteria everywhere), the body produces a larger and larger autoimmune response, with the antibodies further damaging the heart.


“Crusty damaged heart valves lead to very serious complications, such as strokes, pulmonary edema, endocarditis, heart failure, and death. Even one child with such a serious problem is concerning, but unfortunately at LBJ we have treated dozens of children with these problems over the past few years.”


She pointed out that parents should be concerned about rheumatic fever if their child has had fever, joint pain which passes from one area of the body to another, sudden uncontrollable movements of the arms or legs, or an unusual rash. 


Parker explained that the doctor will listen to the heart for a murmur, order studies such as an EKG and chest x-ray, and also check the blood for evidence of streptococcus and inflammation.


“Rheumatic fever is relatively simple to treat, with special doses of aspirin used to quiet the inflammation and an antibiotic injection to fight off the bacteria so the immune system won’t have to produce more harmful antibodies. The catch is that the antibiotic injection wears-off in three to four weeks, so it must be repeated to protect the heart from further damage.”




Parker stated the first step to preventing rheumatic heart disease is avoiding bacteria; and regular scrubbing of the skin with soap and water helps.


“In the tropics, we are plagued with lots of mosquitoes, scabies and other insects. The itchy skin lesions they leave behind are tempting to scratch, and dirt and bacteria enter the skin in this manner. Spraying the skin with an insect repellent containing DEET twice a day is a great way to prevent itchy bug-bites. Streptococcus also causes sore throats.


“Toothbrushes and eating utensils should not be shared with others, to avoid passing sore throats around. Sore throats must be treated within nine days to avoid the risk of developing rheumatic fever. The bottom line is to get skin infections and sore throats checked out by a doctor right away,” she advised.


She went on to say that once a child has been diagnosed with rheumatic fever, the focus turns toward avoiding damage to the heart valves by preventing recurrence of rheumatic fever and this is accomplished with Bicillin antibiotic injections, given every three weeks in the Pediatric clinic.


“An analysis of the data over the past few years shows that children who come in faithfully for their Bicillin injections are less likely to go on to develop severe heart disease. Once damage to the valves occurs, the only option may be heart surgery.


“Our population is too small to afford a full time heart surgeon and the special equipment needed for these highly specialized surgeries, which means that the family will have to seek specialized care off-island,” she stated.


Parker pointed out that experts from the World Heart Federation estimate that for the cost of sending two children off-island for surgery, an RHD prevention program for the entire island could be funded.