Andersons pediatric cardiology 1440

Organization.RheumaticFeverandRheumaticHeartDisease.ReportofaWHOExpert
Consultation,29October–1November2001.WHOtechnicalreportseriesNo.923.Geneva:
WHO;2004;andGerberMA,BaltimoreRS,EatonCB,etal.Preventionofrheumaticfeverand
diagnosisandtreatmentofacutestreptococcalpharyngitis:ascientificstatementfromthe
AmericanHeartAssociationRheumaticFever,Endocarditis,andKawasakiDiseaseCommitteeof
theCouncilonCardiovascularDiseaseintheYoung,theInterdisciplinaryCouncilonFunctional
GenomicsandTranslationalBiology,andtheInterdisciplinaryCouncilonQualityofCareand
OutcomesResearch.Circulation.2009;119:1541–1551.

Oneofthemainconcernsistheadherenceofpatientstotheprophylactic
regimens.Asaconsequenceoftheuseofamedicationinvolvingpainful
administrationordailyoraltherapyforlongperiodsoftime,sometimes
compliancewithprophylacticregimenscanconstituteachallenge,mainlyin
adolescents.Anotherreasontodiscontinueprophylaxiswouldbeincomplete
informationaboutthediseaseandtheneedofprevention,besidesthefearof
allergicreactions.Anaphylaxis,however,isarareevent,andthegreatmajority
ofcasesofhypersensitivityarerepresentedbymildreactions,mainlyskin
rashes.Theriskofaseriouscomplicationislowerinchildrenthaninadults,and
long-termpreventiondoesnotappeartoincreasetheriskofanallergic
reaction.35,232,233Toimprovecompliancewiththeprophylacticregimen,itis
importanttoplanthefollow-upwithpatientsandfamilies.Informationmustbe
givenabouttheimportanceofthecontinuousmedication,andwhyitis
necessarytopreventsubsequentstreptococcalinfections.
PreventionofRFinvolvesmorethanonlytheprescriptionofantibiotics.Ata
populationlevel,theintegrationintoawiderhealthsystemwithanactive
engagementoftheprimaryhealthcarestaffcanincreasethechancesofatimely
diagnosis.Inanysuspiciouscase,beforestartingprophylaxis,anaccurate
diagnosismustbemade,andthisactiondependsonglobalaccesstothehealth
systemandtrainedhealthcareproviders.Surveillance,strategiestoreduce
injectionpain,aclosecommunication,andprovisionofeducationtopatientsand
familiesarecomplementaryactionstopromoteadherencetoprophylaxis

regimensandfollow-up.226


Acknowledgment
WeareindebtedtoLuizaGuilherme,forreviewingthetextinthelightofher
specificareasofexpertise.


AnnotatedReferences
WorldHealthOrganization.RheumaticFeverand
RheumaticHeartDisease:ReportofaWHO
ExpertConsultation.WHO:Geneva;2004.
Geneva,29October–1November2001.WHO
technicalreportseriesNo.923..
ThistechnicalreportfromtheWorldHealth
Organizationcomprisesacompleteandupdated
reviewoftheepidemiologic,pathogenetic,
clinical,therapeutic,andprophylacticaspectsof
rheumaticfeveranditscardiacsequels,withan
extensivelistofreferences..
CarapetisJR,SteerAC,MulhollandEK,WeberM.
Theglobalburdenofgroupastreptococcal
diseases.LancetInfectDis.2005;5:685–694.
Theauthorsevaluatetheburdenofdiseasescaused
bygroupAStreptococcusonaglobalscale
accordingtoareviewofpopulation-baseddata,
highlightingtheimportanceofdeveloping
strategiesforprevention.Itisestimatedthat
morethan336,000casesofrheumaticfever
occurinthoseagedfrom5to14years,andan

annualnumberatmorethan471,000forall
ages.Aboutthree-fifthsofthecases,about
282,000patients,areexpectedtodevelop