Description
Rheumatic heart disease (RHD) affects millions of people worldwide and claims nearly 300,000 lives each year. The disease is a complication of acute rheumatic fever (ARF), an autoimmune inflammatory reaction to streptococcal infections (strep throat). While RHD cases have declined significantly in high-income nations, the same is not true for the developing world, especially where poverty is widespread and access to health services is limited.
On November 1, 3, and 8, 2021, the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) virtually convened a multidisciplinary group of RHD experts to discuss the state of the science and identify research gaps surrounding the prevention and treatment of RHD. View the program book and agenda.
The findings, knowledge gaps, and opportunities described below represent a summary of opinions and ideas expressed during the workshop. These ideas do not represent a consensus or directive, or an expression of research priorities or directions for the NHLBI or NIH.
Select Overview Videos
Keynote Addresses
Nov. 1, 2021
George Mensah, M.D., Director, Center for Translation Research and Implementation Science (CTRIS), NHLBI, NIH, USA
David Goff, Jr., M.D., Ph.D., Director, Division of Cardiovascular Sciences (DCVS), NHLBI, NIH, USA
Kathryn A. Taubert, M.S., Ph.D., Professor, UT Southwestern Medical Center at Dallas; Former Vice President, International Science & Health Strategies, American Heart Association, USA
Opening Remarks by Workshop Chairs
Nov. 1, 2021- Day 1
Jonathan Carapetis, A.M., M.B.B.S., Ph.D., Director, Telethon Kids Institute; Institute Director; Head, Strep A and Rheumatic Heart Disease; Co-Director, REACH (Rheumatic heart disease. Evidence. Advocacy. Communication. Hope), Australian Centre for Control & Elimination of Neglected Tropical Diseases, Australia
Andrea Beaton, M.D., Pediatric Cardiologist, Outreach; Associate Professor, UC Department of Pediatrics, Cincinnati Children’s Hospital, USA
Nov. 3, 2021- Day 2
Andrea Beaton, M.D., Pediatric Cardiologist, Outreach; Associate Professor, UC Department of Pediatrics, Cincinnati Children’s Hospital, USA
Nov. 8, 2021- Day 3
Ana Mocumbi, M.D., Ph.D., Associate Professor of Cardiology at Universidade Eduardo Mondlane (Mozambique); Affiliated Professor, Department of Global Health, University of Washington, USA
Work Group Summaries
Primordial Prevention: Social Determinants of Health and Group A Streptococcal (GAS) Vaccine Development
Work Group Leads
- Maylene Shung King, M.B.Ch.B., Ph.D., Associate Professor, University of Cape Town, South Africa
- Andrew Steer, M.B.B.S., BMedSci, M.P.H., Ph.D., Professor, Director Infection and Immunity, Murdoch Children’s Research Institute Melbourne, Australia
Members
- Michael Baker, M.B.Ch.B., D.Com.H., D.Obst., Professor, Department of Public Health, University of Otago Wellington, New Zealand
- Jerome Kim, M.D., Director General, International Vaccine Institute (IVI), South Korea
- Natalia Korotkova, Ph.D., Assistant Professor, Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, USA
- Karen Sliwa, M.D., Ph.D., D.T.M., Director, Cape Heart Institute, Professor of Cardiology, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, South Africa
Primordial prevention aims to prevent the development of various risk factors for disease. It focuses on individual- and community-level strategies to block initial GAS exposure and/or infection. To better understand which strategies work best, the work group assessed the current status of GAS vaccine-development efforts, and the role that social determinants of health play on disease burden in endemic regions. Importantly, the group also examined how these social determinants of health impact vaccine development efforts, and discussed lessons learned from other vaccine initiatives.
Primary Prevention
Diagnosis and Treatment of GAS Infections and Progression to ARF
Work Group Leads
- Mark Engel, Ph.D., M.P.H., Associate Professor, University of Cape Town, South Africa
- Joselyn Rwebembera, M.B.Ch.B., M.Med., Medical Officer, Uganda Heart Institute, Mulago National Referral Hospital, Uganda
Members
- Chris Van Beneden, M.D., M.P.H., Epidemiologist, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), USA
- Asha Bowen, M.B.B.S., D.C.H., Ph.D., Associate Professor, Head, Skin Health, Program Head of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
- James B. Dale, Ph.D., Professor, The University of Tennessee Health Science Center, USA
- Katherine E. Fleming-Dutra, M.D., Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC, USA
- Amy Sanyahumbi, M.D., Pediatric Cardiologist, Baylor College of Medicine/Texas Children’s Hospital, USA
Primary prevention includes diagnostic, therapeutic, and outreach strategies to prevent disease. These methods aim to reduce the likelihood of GAS pharyngitis progression to the more severe ARF manifestations (e.g., arthritis, carditis, valvulitis, Sydenham chorea). Through pre-workshop discussions, work group members shared current research within the field, discussed critical knowledge gaps, and identified ways to help address those concerns.
Secondary Prevention: ARF and Progression to RHD
Work Group Leads
- Ganesan Karthikeyan, M.D., D.M., M.S., Professor of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, India
- David A. Watkins, M.D., M.P.H., Assistant Professor, Division of General Internal Medicine, Department of Global Health, University of Washington, USA
Members
- Madeleine W. Cunningham, Ph.D., George Lynn Cross Research Professor, Presbyterian Health Foundation Presidential Professor Microbiology and Immunology Director, Immunology Training Program University of Oklahoma Health Sciences Center, USA
- Babu Muhamed, Ph.D., Postdoctoral Fellow, The University of Tennessee Health Science Center, USA
- Anna P. Ralph, Ph.D., Professor, Royal Darwin Hospital, Menzies School of Health Research, Australia
- Nona Sotoodehnia, M.D., M.P.H., Associate Professor, Medicine, Cardiovascular Health Research Unit, University of Washington, USA
- Rosemary Wyber, M.B.Ch.B., M.P.H., Senior Technical Adviser, Strep A and Rheumatic Heart Disease Team, Telethon Kids Institute, Perth Children's Hospital, Australia
Secondary prevention strategies aim to halt the progression of ARF to RHD by identifying and treating people who are most susceptible to disease. To address the most pertinent issues within the field, work group members focused on specific areas, which included but were not limited to enhancing disease burden data collection, developing novel therapeutics, and further supporting global collaborative efforts to improve the translation of clinical findings to standard practice.
Tertiary Care: Management of RHD Complications
Work Group Leads
- Marcelo Cardarelli, M.D., M.P.H., Pediatric Cardiac Surgeon, Inova Women and Children Hospital, USA
- Liesl Zühlke, M.B.Ch.B., D.C.H., M.P.H., M.Sc., Ph.D., Professor, University of Cape Town, South Africa
Members
- Annette Ansong, M.D., Pediatric Cardiologist, Medical Director, Cardiology Outpatient Services, Children’s National Medical Center, USA
- Gene Bukhman, M.D., Ph.D., Director, Program in Global Noncommunicable Disease and Social Change, Harvard University, USA
- Jeffrey Cannon, Ph.D., Postdoctoral Research Fellow, Global Health and Population, Harvard T.H. Chan School of Public Health, USA
- Jacques Kpodonu, M.D., Faculty of Surgery, Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
- Salome Maswine, M.B.Ch.B., M.Med., Ph.D., Professor and Head of Global Surgery, Department of Cardiothoracic Surgery, University of Cape Town, South Africa
- Emmy Okello, M.D., Ph.D., Chief of Cardiology, Uganda Heart Institute, Mulago National Referral Hospital, Uganda
- Bo Reményi, M.B.B.S., Ph.D., Associate Professor, Royal Darwin Hospital, Menzies School of Health Research, Australia
- Craig Sable, M.D., Associate Division Chief, Cardiology; Director, Echocardiography, Children’s National Hospital, USA
- Dominique Vervoort, M.D., M.P.H., C.P.H., M.B.A., Ph.D., Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA
- Chris Yilgwan, M.D., Ph.D., Associate Professor of Pediatrics, University of Jos, Nigeria
Tertiary care aims to optimize care options/access for people with late-stage RHD. This work group recognized that even with the best possible treatment, RHD will continue to affect people worldwide. It then explored ways to optimize the medical and surgical care of people with RHD complications, such as heart failure, heart valve problems, and pregnancy difficulties.
Conclusions and Next Steps
In 2023, work group members will summarize their findings and develop manuscripts for journal submission.
NIH Staff Workshop Organizers
Co-Leads
- Mary Masterson, Ph.D., M.S., Program Officer, CTRIS, NHLBI, NIH
- Kathleen Fenton, M.D., M.S., Chief, Advanced Technologies and Surgery Branch, DCVS, NHLBI, NIH
- Makeda Williams, Ph.D., M.P.H., Global Health Program Director, CTRIS, NHLBI, NIH
Organizing Committee
- Geetha Bansal, Ph.D., Program Director, Division of International Training and Research (DITR), Fogarty International Center (FIC), NIH
- Jenny Baumgartner, Ph.D., American Association for the Advancement of Science (AAAS) and Technology Policy Fellow, Office of Disease Prevention (ODP), NIH
- Fernando Bruno, M.D., M.P.H., AAAS Science and Technology Policy Fellow, Office of the Director, National Institutes of Health
- Michael Engelgau, M.D., M.S., Visiting Scientist and Former Deputy Director, CTRIS, NHLBI, NIH
- David Goff, Jr., M.D., Ph.D., Director, DCVS, NHLBI, NIH
- Melissa C. Green Parker, Ph.D., Health Science Administrator, ODP, NIH
- Xin Xing Gu, Ph.D., Program Officer, Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, NIH
- John Haller, Ph.D., Program Officer, Advanced Technologies and Surgery Branch, DCVS, NHLBI, NIH
- George Mensah, M.D., Director, CTRIS, NHLBI, NIH
- Katelynn Milora, Ph.D., Health Science Policy Analyst, Office of the Director, NIH
- Keith Mintzer, Ph.D., Program Officer, CTRIS, NHLBI, NIH
- Brad Newsome, Ph.D., Program Officer, DITR, FIC, NIH
- Xinzhi Zhang , M.D., Ph.D., Health Inequities and Global Health Branch Chief, NHLBI, NIH