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A 5 year plan for controlling rheumatic heart disease



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10 March 2011

There are real opportunities in the next five years to make dramatic progress in rheumatic fever (RF) and rheumatic heart disease (RHD) control globally and in Australia.  The hard work of a number of key individuals globally and in Australia has led to an invigorated focus, particularly on public health approaches to RHD control and group A streptococcal vaccine development.  We have the attention of governments and service providers nationally and a range of international bodies. Globally, the RHD control approach spearheaded by the World Heart Federation is garnering the attention of WHO and has the potential to draw in major donors and other international organisations. Within Australia, the National RF Strategy provides the infrastructure for delivering improved RF/RHD control. All of this is very promising, and raises hopes that the next five years could be the most important in RHD control since the critical studies of benzathine penicillin G prophylaxis in the mid-20th Century.  But there are several priority research questions that must be answered to make the most of these opportunities.  These include:
•    How can we improve delivery of the interventions that, based on current knowledge, are proven to work, particularly secondary prophylaxis for RHD? 
•    How can we develop a standardised, affordable and sustainable model for echocardiographic screening of RHD in remote communities and developing countries, to identify patients who will benefit from secondary prophylaxis earlier in the evolution of their disease?
•    How can we improve diagnosis and management of ARF, tailoring therapeutic interventions that can improve long term outcome?
Can we develop a proven and effective approach to primary prevention, possibly including a group A streptococcal vaccine that will prevent rheumatic fever in highly-endemic settings?

Professor Jonathan Carapetis
Director, Menzies School of Health Research