Rheumatic Fever: Neglected Again

Science 3 April 2009: Vol. 324. no. 5923, p. 37 DOI: 10.1126/science.324.5923.37b

Letters

Rheumatic Fever: Neglected Again

We appreciate M. Enserink's News of the Week story ("Some neglected diseases are more neglected than others," 6 February, p. 700) on the Moran et al. study analyzing the current state of research into so-called "neglected diseases" (1). We would like to highlight one neglected disease that was neglected once again: rheumatic fever (RF).

RF and its sequel, rheumatic heart disease (RHD), are almost exclusively restricted to developing countries, with a mortality comparable to that of rotavirus, and about 50% of that of malaria (2). According to the George Institute report, only 0.07% of global funding is directed toward RF, much less the treatment and prevention of RHD. This limited allocation for RF illustrates the misdirection of global health funding. Although the complications of RF/RHD are potentially lethal, they are entirely preventable with antibiotic prophylaxis, which has been shown to be cost-effective in individuals with prior group A streptococcal infection (3). Despite the limited scientific understanding of RF/RHD, some developing countries have been able to control the disease, simply by investing heavily in existing technologies and programs (4). In Enserink's words, global investment in RF/RHD would "pay off quickly."

Although Moran et al. note a consensus on preventative vaccine development for RF/RHD, they fail to document two other critical areas of research--epidemiologic surveillance and disease control. Although several promising initiatives for RF/RHD surveillance and control have been recently published (5), funding opportunities for such programs are still rather scant. We encourage the international donor community to critically examine their funding priorities regarding RF/RHD. We also suggest that future surveys by the George Institute researchers include epidemiological and treatment programs, which are crucial to the eradication of neglected diseases.

David A. Watkins
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

Liesl J. Zuhlke
Western Cape Paediatric Cardiac Services
Red Cross War Memorial Children's Hospital
Cape Town 7700, South Africa

Mark E. Engel
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

Bongani M. Mayosi^*
Department of Medicine
Groote Schuur Hospital and University of Cape Town
Cape Town 7925, South Africa

^*To whom correspondence should be addressed. E-mail: bongani.mayosi@uct.ac.za

References

1. M. Moran et al., PLoS Med. 6, e30 (2009).
2. J. R. Carapetis, A. C. Steer, E. K. Mulholland, M. Weber, Lancet Infect. Dis. 5, 685 (2005).
3. K. A. Robertson, J. A. Volmink, B. M. Mayosi, BMC Cardiovasc. Disord. 5, 11 (2005).
4. P. Nordet, R. Lopez, A. Duenas, L. Sarmiento, Cardiovasc. J. Afr. 19, 135 (2008).
5. B. Mayosi et al., S. Afr. Med. J. 96, 246 (2006).

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The editors suggest the following Related Resources on Science sites:

In Science Magazine

NEWS OF THE WEEK
GLOBAL HEALTH: Some Neglected Diseases Are More Neglected Than Others

Martin Enserink (6 February 2009)
Science 323 (5915), 700. [DOI: 10.1126/science.323.5915.700]
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