An epidemiological study to assess the true incidence and prevalence of rheumatic heart disease and acute rheumatic fever in New Caledonian school children

Sydenham's Chorea in Children with Acute Rheumatic Fever: An Echocardiographic Survey of Pediatric Patients in Northwestern Iran

Background

Although infrequent, Sydenham's chorea (SC) may occur as a result of injury to the basal ganglia in children with acute rheumatic fever (ARF) secondary to group A Streptococcal infection. Certain hallmarks of SC, such as movement disorders, could be utilized as a predictive marker for carditis. The present study aimed to investigate neurologic and cardiologic symptoms in children with suspected SC after ARF.

Methods

All children aged 5-16 who were admitted at Shahid Madani Pediatric Hospital (Tabriz, Iran), with an initial diagnosis of ARF and SC between 2009 and 2022 were included for echocardiographic assessment and prospective follow-up within 6 and 12 months after the start point. The pattern and severity of valvulopathy, as well as the prevalence of Jones criteria for rheumatic fever, were used to assess the effect. The collected data were analyzed using SPSS Statistics software (version 22.0) using Chi square and Fisher's exact tests. P<0.05 was considered statistically significant.

Results

The study enrolled 85 children, 36 girls and 49 boys, with a mean age of 9.7±2.7. On the first echocardiography, 42.4% of patients had mitral valve regurgitation (MR), with a predominance of female patients (P=0.04). Of those diagnosed with SC (12 girls and 6 boys), 66.7% showed cardiac involvement, with a higher prevalence of MR in both sexes (P=0.04). The pattern of cardiac involvement after 6 months was significantly different between the groups (P=0.04). However, no such difference was observed during the one-year follow-up (P=0.07). Female sex was found to have a significant relationship with SC localization (P=0.01).

Conclusion

In addition to its neurological manifestations, SC can be associated with clinical or subclinical cardiac valve dysfunction that might last for more than a year. In addition to attempting early detection and appropriate management, a precise cardiac and neurologic assessment during admission and follow-up is recommended.A preprint version of this manuscript is available at DOI: 10.21203/rs.3.rs-772662/v1 (https://www.researchsquare.com/article/rs-772662/v1).

Scabies incidence and association with skin and soft tissue infection in Loyalty Islands Province, New Caledonia: A 15-year retrospective observational study using electronic health records

Background

Scabies and its complications are a public health problem in the low- and middle-income countries of the Western Pacific region. However, no data are available for the relatively wealthy French territory of New Caledonia. This study aimed to determine the incidence of scabies and its association with skin and soft tissue infection (SSTI) in Loyalty Islands Province (LIP) (20,000 inhabitants), New Caledonia.

Methodology/Principal findings

This retrospective observational study reviewed cases of scabies and SSTI extracted from the electronic health record databases of LIP clinics for the period 2004–2018. Data were validated through double sampling. The overall scabies incidence rate (IR) and scabies IRs by sex and age group were calculated. Scabies seasonality was evaluated. For children <5 years, the presence of SSTI was compared between the 3-month period preceding scabies diagnosis/treatment and the 3-month period preceding the 1-year anniversary of scabies diagnosis/treatment (self-matching).

A total of 16,843 scabies cases were extracted using a detection algorithm with a sensitivity of 96.7% and a specificity of 99.9%. From 2004 to 2018, the average overall scabies IR was 5.9% and the average scabies IR in children <1 year was 18.4%. Almost two-thirds of children aged 14 years had a history of scabies. Females were more affected, especially in the 20–39 age group (sex ratio>2). A strong seasonality was observed, with a 30% increase in winter. In children <5 years, SSTIs were 4.3 times more frequent in the 3 months preceding the scabies diagnosis than in the 3 months preceding the 1-year anniversary of scabies treatment (p<0.001).

Conclusions

Although health care is much better in New Caledonia than in neighboring countries, scabies is highly endemic in LIP. The disease is especially common in children <2 years and is associated with many SSTIs in children <5 years. Mass drug administration should be considered.

Scabies is a known public health problem in the Pacific region. This study aimed to determine the importance of scabies and associated skin infections in the Loyalty Island Province (LIP) of New Caledonia (20,000 inhabitants).

The provincial electronic medical database was searched for all cases of scabies and skin infection that occurred in the LIP population between 2004 and 2018. To evaluate the impact of scabies on skin infections, we measured the decrease in the number of skin infections in children <5 years one year after scabies treatment.

Over the study period, the average number of scabies cases occurring each year was 6 per 100 inhabitants. In children <1 year, this number was 18 per 100 inhabitants. We found that 80% of children aged 15 years had experienced at least one episode of scabies. We also observed a fourfold decrease in the number of skin infections in children <5 years 1 year after treatment. Scabies was more frequent (+30%) in winter.

Toward the Knowledge of the Epidemiological Impact of Acute Rheumatic Fever in Italy

Background: To estimate the incidence of Acute Rheumatic Fever (ARF) in Tuscany, a region of Central Italy, evaluating the epidemiological impact of the new diagnostic guidelines, and to analyse our outcomes in the context of the Italian overview. Methods: A multicenter and retrospective study was conducted involving children <18 years old living in Tuscany and diagnosed in the period between 2010 and 2019. Two groups were established based on the new diagnostic criteria: High-Risk (HR) group patients, n = 29 and Low-Risk group patients, n = 96. Results: ARF annual incidence ranged from 0.91 to 7.33 out of 100,000 children in the analyzed period, with peak of incidence registered in 2019. The application of HR criteria led to an increase of ARF diagnosis of 30%. Among the overall cohort joint involvement was the most represented criteria (68%), followed by carditis (58%). High prevalence of subclinical carditis was observed (59%). Conclusions: Tuscany should be considered an HR geographic area and HR criteria should be used for ARF diagnosis in this region.

Screening Rheumatic Heart Disease in 1530 New Caledonian Adolescents

BACKGROUND

In New Caledonia, a South Pacific archipelago whose inhabitants comprise Melanesians, Europeans/whites, Wallisians, Futunans, Polynesians, and Asians, the prevalence of rheumatic heart disease (RHD) is 0.9% to 1% at ages 9 and 10. It could be higher at the age of 16, but this remains to be verified.

METHODS AND RESULTS

A total of 1530 Melanesian, Métis, white, Wallisian, Futunan, Polynesian, and Asian adolescents benefited from a transthoracic echocardiogram. Definite or borderline RHD, nonrheumatic valve lesions, congenital heart defects, family and personal history of acute rheumatic fever, and socioeconomic factors were collected. The prevalence of cardiac abnormalities was 8.1%, made up of 4.1% RHD including 2.4% definite and 1.7% borderline RHD, 1.7% nonrheumatic valve lesions, and 2.3% congenital anomalies. In whites and Asians, there were no cases of RHD. RHD was higher in the Wallisian, Futunan, and Polynesian group (7.6%) when compared with Melanesians (5.3%) and Métis (2.9%). The number of nonrheumatic valve lesions was not statistically different in the different ethnicities. The prevalence of RHD was higher in adolescents with a personal history of acute rheumatic fever, in those living in overcrowded conditions, and in those whose parents were unemployed or had low‐income occupations, such as the farmers or manual workers.

CONCLUSIONS

RHD was 4 times higher in adolescents at age 16 than at ages 9 and 10 (4.1% versus 0.9%–1%). No cases of RHD were observed in whites and Asians. The determining factors were history of acute rheumatic fever and socioeconomic factors.

Acute rheumatic fever

Acute rheumatic fever is caused by an autoimmune response to throat infection with Streptococcus pyogenes. Cardiac involvement during acute rheumatic fever can result in rheumatic heart disease, which can cause heart failure and premature mortality. Poverty and household overcrowding are associated with an increased prevalence of acute rheumatic fever and rheumatic heart disease, both of which remain a public health problem in many low-income countries. Control efforts are hampered by the scarcity of accurate data on disease burden, and effective approaches to diagnosis, prevention, and treatment. The diagnosis of acute rheumatic fever is entirely clinical, without any laboratory gold standard, and no treatments have been shown to reduce progression to rheumatic heart disease. Prevention mainly relies on the prompt recognition and treatment of streptococcal pharyngitis, and avoidance of recurrent infection using long-term antibiotics. But evidence for the effectiveness of either approach is not strong. High-quality research is urgently needed to guide efforts to reduce acute rheumatic fever incidence and prevent progression to rheumatic heart disease.

Common risk indicators for oral diseases and obesity in 12-year-olds: a South Pacific cross sectional study

BACKGROUND

Despite the increasing need to prevent obesity and oral diseases in adolescents worldwide, few studies have investigated the link existing between these conditions and their common risk factors. This study aims to evaluate the oral health and weight status of New Caledonian Children (aged 6,9,12 years) and to identify, amongst 12-year-olds, risk indicators that may characterize the groups of children affected by oral diseases, obesity or both diseases.

METHODS

This survey evaluated in 2011-2012 the oral health and stature-weight status and related risk indicators in a national representative sample of 6, 9 and 12 years-old children in New Caledonia. Dental status, chewing efficiency, height, weight and waist circumference were clinically recorded at school. The body mass index (BMI) and the waist to height ratio (WtHR) were calculated. For BMI the WHO Cut-offs were used. Twelve years-old participants responded to a questionnaire concerning socio-demographic and behavioural variables. For statistical analysis, the Clinical Oral and Global Health Index (COGHI) was developed and used. Twelve years-old children were categorised into four groups; Oral Diseases (ODG), Obesity (OG), Obesity and Oral Diseases (ODOG) and a Healthy Group (HG). A multivariate analysis was conducted using mixed-effects multinomial logistic regression models.

RESULTS

Prevalence of overweight and obesity was greatly increasing from 6 years (respectively 10.8% [8.8;13.3] and 7.8% [6.0;9.9]) to 12 years (respectively 22.2% [19.9;24.7] and 20.5% [18.2;22.9]) and one third of the 12-yr-olds had an excess of abdominal adiposity. At age 12, 36.6% of the children were healthy (HG), 27.3% had oral diseases (ODG), 19.7% were obese (OG) and 16.5% had both conditions (ODOG). Geographical location, ethnicity, tooth-brushing frequency and masticatory disability were significant risk factors for the OG, ODOG and ODG groups. Ethnicity and masticatory impairment were common risk indicators for the association of oral diseases and obesity.

CONCLUSIONS

In NC health promotion programs should be specifically addressed towards Native populations who are particularly exposed to oral diseases and obesity, integrating a multiple risk factors approach, in order to prevent the onset of chronic diseases in adulthood. The impact of masticatory ability on children's weight status is a major issue for future research.