Oldest antibiotic prevents rheumatic heart disease, but India’s burden still high. Here’s why

New Delhi: Much has been written about India’s burden of non-communicable diseases such as diabetes and hypertension, but some of them also have an infectious disease component. One of these is rheumatic heart disease, which mainly affects the heart valves.

Rheumatic heart disease (RHD) can start with something as harmless as a sore throat. Although it has fallen due to improvements in living conditions, the burden of RHD in India is among the highest in the world. And yet the disease can be prevented by using penicillin – the oldest antibiotic known to mankind.

According to an ongoing Global Burden of Disease (GBD) study — what’s outsprings by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in absolute numbers, India accounts for a third of the global RHD burden.

The disability-adjusted life year (DALY) is an internationally recognized measure of morbidity and mortality associated with a particular disease. A DALY represents the loss of the equivalent of a year of full health.

The GBD study estimated that RHD led to 395 DALYs per 100,000 population in India and 9.2/1 million deaths in 1990, authors of the Rajasthan University of Health Sciences wrote in a 2020 article in the Journal of the Association of Physicians of IndiaJAPIA† This dropped to 270/1,000,000 DALYs and 7.9/1,000,000 deaths in 2017

In absolute terms, RHD led to 3.44 million (34.4 lakh) DALYs and 80,470 deaths in India in 1990, rising to 3.73 million DALYs and 1,08,460 deaths in 2017, they further wrote.

According to the World Health Organization (WHO), “Rheumatic heart disease starts as a sore throat due to a bacteria called” Streptococcus pyogenes (group A streptococci) that can easily pass from person to person in the same way as other upper respiratory infections.”

Strep infections are most common in childhood. In some people, repeated strep causes the immune system to react against the tissues of the body, including inflammation and scarring of the heart valves. This is called rheumatic fever. Rheumatic heart disease results from the inflammation and scarring of heart valves caused by rheumatic fever.”

Administration of long-acting penicillin can prevent the progression of the infection to a stage where it affects the functioning of the heart, but the drug – discovered by Alexander Fleming in 1928 – is prone to periodic shortages. It’s too cheap for drug companies to make a profit, so countries using it worldwide are struggling to come up with subsidy plans to keep the penicillin flow stable.

Nevertheless, a study 2019 in the lancet medical journal analyzing antibiotic use in India – the findings of which were published Wednesday – shows that penicillin-class antibiotics are among the best consumed in India, second only to cephalosporins.

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Not all sore throats need antibiotics

However, doctors are careful not to put too much emphasis on the sore throat for fear of overusing antibiotics. dr. Ganesan Karthikeyan, professor of cardiology at the All India Institute of Medical Sciences (AIIMS), Delhi, told ThePrint: “An average child will probably have five sore throats a year. About 10 to 15 percent of all sore throats are caused by: Streptococci and 0.3 percent of that can become RHD.”

According to Dr. Karthikeyan is India’s RHD burden because it has a very large population. He added: “It is actually a disease of poverty and overcrowding, and it mainly affects children. That is why, as the standard of living rises, so does the disease prevalence. For example, the latest ICMR survey found that RHD prevalence in Kerala is very low. But primary prevention is not practical because it is a very expensive affair, even if penicillin is available.”

“Even countries like New Zealand found no merit in that plan. Randomized trials of sore throat screening and primary prevention were unsuccessful in reducing the prevalence of RHD,” he added.

According to a 2019 article in the Indian Journal of Public HealthRHD is an endemic disease in India, good for 1,19,100 dead every year. In 2015, India had the highest RHD burden in the world.

Rheumatic fever, which can occur several weeks after the sore throat, caused by: StreptococciIn addition to fever, the patient may also suffer from joint pain, fatigue and skin rash. The symptoms of heart valve damage may include chest pain, shortness of breath, and fast or irregular heartbeat.

‘Primary & secondary prevention’

dr. KS Reddy, former professor of cardiology at AIIMS and chairman of the Public Health Foundation of India, told ThePrint: “There are two aspects to this (prevention of RHD) – primary prevention and secondary prevention. It is believed that if a patient with a sore throat thought to be caused by the Streptococci If the bacteria are given penicillin early, the autoimmune response that causes rheumatic heart disease can be stopped.”

“But to confirm whether it is indeed the case Streptococci, one has to do a throat swab culture, which is not always easy. Accuracy is lower for rapid diagnostic tests,” he added.

He added that there are risks of using penicillin indiscriminately without confirmation, as nearly 90 percent of sore throats are viral in origin.

“Some countries have attempted diagnosis using a clinical score and giving penicillin to those patients who meet the predetermined score.”

“There is a secular (long term) trend of RHD declining in India but there is no doubt that the disease is associated with socioeconomic underdevelopment, overpopulation. There has also been an issue with the availability of long-acting penicillin since the Hindustan Antibiotics shutdown,” he said, referring to the Pune-based company. company, India’s first state-owned drug manufacturer, owned by Ministry of Chemicals and Fertilizers.

(Edited by Gitanjali Das)

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