A Review of Acute Rheumatic Fever and Rheumatic Heart Disease Research in Malaysia

A total of 39 titles related to rheumatic fever or rheumatic heart disease in Malaysia were found with online literature search dating back to their inceptions and through 2014. Additional publications from conference journals were included. Nine papers were selected based on clinical relevance and future research implications. There were no population-based studies on the incidence or prevalence of ARF or RHD. In the 1980s, the incidence of admission due to ARF ranged from 2 to 21.1 per 100 000 paediatric admission per year. The burden of disease was significant in the adult population; 74.5% of patients with RHD were female, of which 77.1% were in the reproductive age group of 15-45 years old. Rheumatic mitral valve disease constituted almost half (46.7%) of all mitral valve repairs, ranging from 44.8 – 55.8 patients per year from 1997 – 2003. From 2010-2012, mitral valve interventions increased to 184 per year, of which 85.7% were mitral valve repair. In children with ARF, 25.4% - 41.7% had past history of rheumatic fever or RHD. In patients with rheumatic mitral valve disease undergoing surgical or medical interventions, only 6% reported history of ARF, none had history of GABHS pharyngitis or antibiotic prophylaxis. Only 44.7% of patients with RHD on follow-up were on intramuscular benzathine penicillin prophylaxis. Overall, there is scarcity of publications on ARF and RHD in Malaysia. Priority areas for research include determination of the incidence and prevalence of ARF and RHD, identification of high-risk populations, evaluation on the implementation and adherence of secondary preventive measures, identification of subclinical RHD especially amongst the high-risk population, and a surveillance system to monitor and evaluate preventive measures, disease progression and outcomes.

Compliance with intramuscular penicillin prophylaxis in children with sickle cell disease in Jamaica / Cumplimiento de las normas terapéuticas en la profilaxis con penicilina intramuscular en niños jamaicanos con anemia falciforme

OBJECTIVES: Penicillin prophylaxis is important in the defence against invasive pneumococcal disease in sickle cell disease (SCD). Penicillin may be administered by the oral route or by the intramuscular (IM) route. Compliance with the oral route, although difficult to assess, has been reported to be highly variable and often poor. We sought to determine the compliance rate with intramuscular penicillin (IM) prophylaxis in children with sickle cell disease. METHODS: Children followed at the Sickle Cell Unit in Jamaica were recruited. Good compliance was deemed if patients received at least 10 injections over the preceding 12months. Children on IM prophylaxis for less than a 12month period were deemed to be compliant if they received 80! of injections since commencing prophylaxis. RESULTS: Data were available for 78 (HB SS 73; male 42) patients attending the clinic during the period of observation. Sixtynine (88.5!) of the children were compliant with IM penicillin prophylaxis. CONCLUSIONS: This study reports a high compliance (88.5!) to IM penicillin prophylaxis which was associated with an incidence rate of invasive pneumococcal disease lower than what is seen in other comparable studies, reflecting the route of administration. Intramuscular penicillin prophylaxis, despite challenges, is a practical option. It can contribute to better patient compliance and thus significantly impact global rates of invasive pneumococcal disease and its complications in children with SCD and other similar conditions.

OBJETIVO: La profilaxis con penicilina es importante en la defensa contra la enfermedad neumocócica invasiva de la enfermedad de células falciformes (ECF). La penicilina puede administrarse por vía oral o por vía intramuscular (IM). El cumplimiento terapéutico por vía oral - aunque es difícil de evaluar-se ha reportado como altamente variable y a menudo pobre. Se buscó determinar la tasa de cumplimiento terapéutico con la profilaxis de penicilina intramuscular (IM) en niños con enfermedad de células falciformes. MÉTODOS: Se reclutaron niños bajo seguimiento en la Unidad de Células Falciformes en Jamaica. Se consideraba un buen cumplimiento el que los pacientes recibieran al menos 10 inyecciones en los últimos 12 meses. Se consideraba que los niños bajo profilaxis IM por un período menor de 12 meses habían cumplido las normas terapéuticas, siempre que hubiesen recibido el 80! de las inyecciones desde el comienzo de la profilaxis. RESULTADOS: Hubo datos disponibles para 78 (HB SS 73; 42 hombres) pacientes que asistieron a la clínica durante el período de observación. Sesenta y nueve (88,5!) de los niños cumplieron con las normas de la profilaxis con penicilina IM. CONCLUSIONES: Este estudio reporta un alto cumplimiento (88,5!) con la profilaxis de la penicilina IM, asociado con una tasa de incidencia de la enfermedad neumocócica invasiva, inferior a la que se observa en otros estudios comparables que reflejan la vía de administración. A pesar de los desafíos, la profilaxis con penicilina intramuscular, es una opción práctica. Puede contribuir a un mejor cumplimiento del paciente, y así afectar significativamente las tasas globales de la enfermedad neumocócica invasiva y sus complicaciones en niños con ECF y otras condiciones similares.