1. PREVENTION OF RHEUMATIC FEVER Dr. Animesh Mishra, DM (Delhi University) Associate Professor Department of Cardiology NEIGRIHMSShillong-12

2. What is Acute Rheumatic fever ? Infectious Immunological Genetic Collagen Vascular Disease Or an unidentified factor.

3. Is It Possible to Prevent Rheumatic Fever ? Primordial Prevention Primary Prevention Secondary Prevention

4. Primordial prevention Preventing the development of ‘risk factors’ Measures for Primordial Prevention 1- Improvement in Socio-Economic Status 2- Prevention of overcrowding 3- Availability of Prompt Medical care 4- Public Education

5. Primary Prevention Measures for Primary Prevention Identification (GAS) Eradication (Penicillin) Susceptible individuals ? Anti Streptococcal Vaccine Theoretical possibility at the community but Possible at individual level

6. Community level prevention ‘ Sledge Hammer Approach ’ 3%-20% of sore throat are GAS.3% of GAS sore throat result in RF 90% of Patients of RF develops RHD 10000 Sore throats 300 2000..3% RF 16 90%RHD 1 5 10000 3%-20% GAS

7. Identification and Eradication of GAS -Not Feasible at community level 1- Asymptomatic sore throat 2- Diagnosis at mass level 3- Identification Methods not 100%senstive and specific 4- Route of infection 5- Non compliance with the oral Treatment 6- Treatment failure (Penicillin failure)

8. Susceptible individuals HLA-D 1,2,3,4 HLA –D 8/17 Indian population B cell alloantigen Results can not be utilized at community level

9. Rheumatic Vaccine Strain specific M-Protein Caveats 1-Hundreds of Strains 2- Fast mutation rate 3- Virulent GAS may not produce M-Protein Polyvalent vaccines- Tried, but not successful

10. Conserved C-Terminus of M-protein C-5a Peptidase Fibro nectin surface binding Protein (sfb-1) Chemaric peptide J8 Polysaccharide conjugated with protein

11. Health Education (5-16 years) Education by Parents Teachers All India Radio Doordarshan NICs, CICs

12. Health Education (5-16 years) Education by Parents Teachers All India Radio Doordarshan NICs, CICs

13. Secondary Prevention Secondary Attack Rate -50% Penicillin Prophylaxis – Every 2-3 weeks (Depending upon the Age, Wt, Muscle mass ) Duration of prophylaxis – LIFE LONG 10Yrs/ Adulthood 5Yrs/ 18Yrs. 1Yrs Anaphylactic Shock: 1: 1000000= 10 5 Secondary Prevention cannot reduce the burden of RHD SS