Karthikeyan Ganesan, Mayosi Bongani M
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Circulation. 2009 Aug 25;120(8):709-13. doi: 10.1161/CIRCULATIONAHA.108.836510. Epub 2009 Aug 10.
Rheumatic fever and rheumatic heart disease continue to be major public health problems in the developing world, particularly in the countries of sub-Saharan Africa. Because of its cost effectiveness, secondary prophylaxis is advocated as the principal means of disease prevention and control. However, in developing countries, valvular damage, due to earlier, unrecognized episodes of rheumatic fever, has already occurred by the time secondary prophylaxis is instituted. Secondary prophylaxis cannot reduce the incidence of new cases of rheumatic fever and has not been shown to alter the natural history of rheumatic valvular disease. Experience from several regions of the world suggests that incorporation of a strategy of primary antibiotic prophylaxis into a comprehensive program for disease control can reduce the incidence of rheumatic fever and rheumatic heart disease. In this article, we argue that a strategy of primary antibiotic prophylaxis, with appropriate modifications, can be successfully implemented in resource-poor settings across the world and should be a key component of any rheumatic heart disease control program. This, we believe, is essential for reducing the global burden of rheumatic heart disease.
风湿热和风湿性心脏病仍然是发展中世界的主要公共卫生问题，尤其是在撒哈拉以南非洲国家。由于其成本效益，二级预防被倡导为疾病预防和控制的主要手段。然而，在发展中国家，在开始二级预防时，由于早期未被识别的风湿热发作，瓣膜损害已经发生。二级预防不能降低风湿热新病例的发病率，也未显示能改变风湿性瓣膜病的自然病程。世界几个地区的经验表明，将一级抗生素预防策略纳入全面的疾病控制计划可以降低风湿热和风湿性心脏病的发病率。在本文中，我们认为，经过适当调整的一级抗生素预防策略可以在世界各地资源匮乏的环境中成功实施，并且应该成为任何风湿性心脏病控制计划的关键组成部分。我们相信，这对于减轻全球风湿性心脏病负担至关重要。
