SREE CHITHRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES TECHNOLOGY

J% of patients develop rheumatic fever. ICMR has projected that 2 II per thousandschool children and 1.22 per thousand of adult population in India have rheumaticfever or rheumatic heart disease(6). Considering the fact that 49 1 % of Indian populationarc school age children, we have a load of 1.2 -2 millions patients with this problem.This is alarming when we take into account that there are only 30 hospitals in Indiacapable of performing surgery for RHO, majority of them performing less that 200 suchsurgeries per year. Our health budget is a meager 2% of our GOP.6. Most of the patientsdie of RHO in the prime of their life for lack of money and availability of treatment. It isimpossible for a country like ours to handle such a heavy burden.Only rheumatogenic strains of GAS, infecting throat, virulent enough to causeimmunologic response in the host cause rheumatic fever(7,8,9, I 0). Streptococcal throatcolonization has not been known to have any effect in pathogenesis(29). The number ofstreptococcal infections has neither increased nor decreased in the last I 00years.( 1,1 I, 12,13 ). GAS is found in appreciable number of carrier throats. 15 to 25'Yt, ofchildren arc carriers, making eradication of carrier state nearly impossible. A highlycJTicicnt vaccine supplied through an extremely efficient public health system may be ananswer for this menace. But this may not be financially viable. Since rheumatic episodeshave a tendency to recur with no prophylaxis - it could recur as many as 5 times in anaverage patientand has higher chance of recurrence in those who had it once and thedamage gets worse with every recurrence, secondary prophylaxis prmmscs the bestpossible intervention in our population( 14 ).