Banday Aaqib Zaffar, Mondal Sanjib, Barman Prabal, Sil Archan, Kumrah Rajni, Vignesh Pandiarajan, Singh Surjit
Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Front Cardiovasc Med. 2021 Jun 24;8:694393. doi: 10.3389/fcvm.2021.694393. eCollection 2021.
Rheumatic heart disease (RHD), the principal long-term sequel of acute rheumatic fever (ARF), has been a major contributor to cardiac-related mortality in general population, especially in developing countries. With improvement in health and sanitation facilities across the globe, there has been almost a 50% reduction in mortality rate due to RHD over the last 25 years. However, recent estimates suggest that RHD still results in more than 300,000 deaths annually. In India alone, more than 100,000 deaths occur due to RHD every year (Watkins DA et al., N Engl J Med, 2017). Children and adolescents (aged below 15 years) constitute at least one-fourth of the total population in India. Besides, ARF is, for the most part, a pediatric disorder. The pediatric population, therefore, requires special consideration in developing countries to reduce the burden of RHD. In the developed world, Kawasaki disease (KD) has emerged as the most important cause of acquired heart disease in children. Mirroring global trends over the past two decades, India also has witnessed a surge in the number of cases of KD. Similarly, many regions across the globe classified as "high-risk" for ARF have witnessed an increasing trend in the incidence of KD. This translates to a double challenge faced by pediatric health care providers in improving cardiac outcomes of children affected with ARF or KD. We highlight this predicament by reviewing the incidence trends of ARF and KD over the last 50 years in ARF "high-risk" regions.
风湿性心脏病（RHD）是急性风湿热（ARF）的主要长期后遗症，一直是普通人群中心脏相关死亡率的主要促成因素，尤其是在发展中国家。随着全球卫生和环境卫生设施的改善，在过去25年中，因风湿性心脏病导致的死亡率几乎降低了50%。然而，最近的估计表明，风湿性心脏病每年仍导致超过30万人死亡。仅在印度，每年就有超过10万人死于风湿性心脏病（沃特金斯·达等，《新英格兰医学杂志》，2017年）。儿童和青少年（15岁以下）至少占印度总人口的四分之一。此外，急性风湿热在很大程度上是一种儿科疾病。因此，在发展中国家，儿童群体需要特别关注，以减轻风湿性心脏病的负担。在发达国家，川崎病（KD）已成为儿童后天性心脏病的最重要原因。与过去二十年的全球趋势一样，印度的川崎病病例数也出现了激增。同样，全球许多被归类为急性风湿热“高风险”的地区，川崎病的发病率也呈上升趋势。这意味着儿科医疗服务提供者在改善患有急性风湿热或川崎病的儿童的心脏预后方面面临双重挑战。我们通过回顾急性风湿热“高风险”地区过去50年中急性风湿热和川崎病的发病率趋势来突出这一困境。
