Table 11.3, Major Categories of Interventions for the Prevention and Control of RHD - Cardiovascular, Respiratory, and Related Disorders

Intervention	Rationale	Estimated efficacy or effectiveness	Comments
Vaccination against group A streptococcus	Prevent streptococcal sore throat infection	100 percent (theoretical) efficacy at preventing strep throat and ARF or RHD	No vaccine has yet been developed to cover all major serotypes affecting LMICs.
Primary prevention of ARF with benzathine penicillin G	Prevent development of first episode of ARF	80 percent relative risk reduction	Most trials conducted in 1950s and 1960s in young American males.
Secondary prevention of ARF and RHD with benzathine penicillin G	Prevent recurrent episodes of ARF and recurrent and progressive heart valve damage	55 percent relative risk reduction (penicillin vs. control); 87 percent to 98 percent relative risk reduction (injectable versus oral penicillin)	Trials are generally of poor quality and heterogeneous methodology, making results difficult to extrapolate.
Surgical and percutaneous management of established RHD	Palliate cases of advanced RHD with heart failure	Variable effectiveness: Depends on severity of disease, number of heart valves involved, and surgical technique	No controlled trials comparing surgical treatment to no therapy or to medical therapy. Percutaneous treatment of mitral stenosis can be very effective in well-selected cases but generally requires surgical capacity as a backup.

Intervention

Rationale

Estimated efficacy or effectiveness

Comments

Vaccination against group A streptococcus

Prevent streptococcal sore throat infection

100 percent (theoretical) efficacy at preventing strep throat and ARF or RHD

No vaccine has yet been developed to cover all major serotypes affecting LMICs.

Primary prevention of ARF with benzathine penicillin G

Prevent development of first episode of ARF

80 percent relative risk reduction

Most trials conducted in 1950s and 1960s in young American males.

Secondary prevention of ARF and RHD with benzathine penicillin G

Prevent recurrent episodes of ARF and recurrent and progressive heart valve damage

55 percent relative risk reduction (penicillin vs. control);
87 percent to 98 percent relative risk reduction (injectable versus oral penicillin)

Trials are generally of poor quality and heterogeneous methodology, making results difficult to extrapolate.

Surgical and percutaneous management of established RHD

Palliate cases of advanced RHD with heart failure

Variable effectiveness: Depends on severity of disease, number of heart valves involved, and surgical technique

No controlled trials comparing surgical treatment to no therapy or to medical therapy.
Percutaneous treatment of mitral stenosis can be very effective in well-selected cases but generally requires surgical capacity as a backup.

From: Chapter 11, Structural Heart Diseases

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Table 11.3Major Categories of Interventions for the Prevention and Control of RHD

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