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PREVENTION OF RHEUMATIC FEVER. Dr. Animesh Mishra, DM (Delhi University) Associate Professor Department of Cardiology NEIGRIHMS Shillong-12. What is Acute Rheumatic fever ?. Infectious Immunological Genetic Collagen Vascular Disease Or an unidentified factor. ?.

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PREVENTION OF RHEUMATIC FEVER


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    1. PREVENTION OF RHEUMATIC FEVER Dr. Animesh Mishra, DM (Delhi University) Associate Professor Department of Cardiology NEIGRIHMS Shillong-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 10000 3%-20% GAS 2000 300 1 .3% RF 6 . 90%RHD 5 1

    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 PreventionSecondary 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= 105 Secondary Prevention cannot reduce the burden of RHD SS