Epidemiology of rheumatic fever and rheumatic heart disease in the pediatric population, American Samoa, April 2013

Background/Significance:  Rheumatic fever and rheumatic heart disease (RF/RHD) have largely been eliminated in the U.S. since the introduction of penicillin and improvements in sanitation.  Despite this advance, high prevalence persists within the U.S. in the Pacific Islander community.

Objective/Purpose:  This study’s purpose is to describe the epidemiology of RF/RHD in a highly-prevalent area of the U.S.—American Samoa.  The study describes the demographics of patients within the pediatric population, the incidence of RF in 2012, and the prevalence of RHD as of April 2013.

Methods:  A medical record review was conducted at LBJ Tropical Medical Center in Pago Pago, American Samoa, in April 2013.  Data were collected on the demographics of 167 pediatric RF/RHD patients, including age at diagnosis, current age, sex, ethnicity, and village of residence.  Patients were identified as either RF without mention of carditis or RHD with evidence of carditis; whether or not they had received an echocardiogram; whether or not they had documented history of congestive heart failure; and whether or not they had received valvular surgery. 

Results:  Of the 167 patients, 49.7% had a history of RF without documented carditis.  Another 49.7% had documented RHD.  Among all cases, 4.2% had a documented history of congestive heart failure, and 1.8% had documented cardiac surgery.  The 2012 incidence of RF among the 5-14 year-old age group was 234 per 100,000 children.  The prevalence of RHD among children ages 5-14 years was 4.1 per 1,000 children.

Discussion/Conclusion:  The current study is the first of its kind to document endemic RF/RHD in the U.S. at levels that approach epidemic proportions not seen elsewhere in the U.S. since the introduction of improved sanitation and penicillin.  The results indicate an urgent need for targeted interventions to prevent this life-threatening disease.