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Epidemiological trends of RF/RHD in school children of Shimla in north India.
[acute rheumatic fever]
There
are
no
active
surveillance
studies
reported
from
South
East
Asian
Region
to
document
the
impact
of
change
in
socio-economic
state
on
the
prevalence
of
rheumatic
fever
/
rheumatic
heart
disease
(
RF
/
RHD
)
in
children
.
Therefore
,
we
conducted
a
study
to
determine
the
epidemiological
trends
of
RF
/
RHD
in
school
children
of
Shimla
city
and
adjoining
suburbs
in
north
India
and
its
association
with
change
in
socio-economic
status
.
Active
surveillance
studies
were
conducted
in
2007
-
2008
in
urban
and
rural
areas
of
Shimla
,
and
15145
school
children
,
aged
5
-
15
yr
were
included
and
identical
screening
methodology
as
used
in
earlier
similar
survey
conducted
in
1992
-
1993
was
used
.
The
study
samples
were
selected
from
schools
of
Shimla
city
and
adjoining
rural
areas
by
multistage
stratified
cluster
sampling
method
in
both
survey
studies
.
After
a
relevant
history
and
clinical
examination
by
trained
doctor
,
echocardiographic
evaluation
of
suspected
cases
was
done
.
An
updated
Jones
(
1992
)
criterion
was
used
to
diagnose
cases
of
acute
rheumatic
fever
(
ARF
)
and
identical
2
D-
morphological
and
Doppler
criteria
were
used
to
diagnose
RHD
in
both
the
survey
studies
.
The
socio-economic
and
healthcare
transitions
of
study
area
were
assessed
during
the
study
interval
period
.
Time
trends
of
prevalence
of
RF
/
RHD
revealed
about
five-fold
decline
from
2
.
98
/
1000
(
95
%
C
.
I
.
2
.
24
-
3
.
72
/
1000
)
in
1992
-
1993
to
0
.
59
/
1000
(
95
%
C
.
I
.
0
.
22
-
0
.
96
/
1000
)
in
2007
-
2008
.
(
P
<
0
.
0001
)
.
While
the
prevalence
of
ARF
and
RHD
with
recurrence
of
activity
was
0
.
176
/
1000
and
0
.
53
/
1000
,
respectively
in
1992
-
1993
,
no
case
of
RF
was
recorded
in
2007
-
2008
study
.
Prevalence
of
RF
/
RHD
was
about
two
-
fold
higher
in
rural
school
children
than
urban
school
children
in
both
the
survey
studies
(
4
.
42
/
1000
vs
.
2
.
12
/
1000
)
and
(
0
.
88
/
1000
vs
.
0
.
41
/
1000
)
,
respectively
.
The
indices
of
socio-economic
development
revealed
substantial
improvement
during
this
interim
period
.
The
prevalence
of
RF
/
RHD
has
declined
by
five-fold
over
last
15
yr
and
appears
to
be
largely
contributed
by
improvement
in
socio-economic
status
and
healthcare
delivery
systems
.
However
,
the
role
of
change
in
the
rheumatogenic
characteristics
of
the
streptococcal
stains
in
the
study
area
over
a
period
of
time
in
decline
of
RF
/
RHD
can
not
be
ruled
out
.
Policy
interventions
to
improve
living
standards
,
existing
healthcare
facilities
and
awareness
can
go
a
long
way
in
reducing
the
morbidity
and
mortality
burden
of
RF
/
RHD
in
developing
countries
.
Diseases
Validation
Diseases presenting
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated
