title: Streptococcal pharyngitis, rheumatic fever and rheumatic heart disease: Eight-year prospective surveillance in Rupnagar district of Punjab, India.
abstract: BACKGROUND
  Rheumatic fever (RF)/rheumatic heart disease (RHD) continue to be a neglected public health priority. We carried out a registry-based control project, prospective surveillance and sample surveys to estimate the burden of disease.
  
  
  METHODS
  We trained healthcare providers and established a surveillance system for the 1.1 million population of Rupnagar district in Punjab. In sample surveys conducted among schools, physicians examined the sampled children. Children with a cardiac murmur were investigated by echocardiography. Throat swabs were obtained from a sub-sample, and group A streptococci (GAS) were identified and emm typed by standard laboratory methods. We estimated the morbidity rates for RF/RHD from surveillance data and school surveys using a correction factor to account for under-registration of cases in the registry.
  
  
  RESULTS
  A total of 813 RF/RHD cases were registered from 2002 to 2009. Of the 203 RF and 610 RHD cases, respectively, 51.2% and 36.7% were males. In the age group of 5-14 years, RF was more common (80%) than RHD (27%). The prevalence of RF/RHD in 5-14-year-old students was 1.0/1000 (95% CI 0.8-1.3). The school survey indicated that about two-thirds of the RF/RHD cases were enrolled in the hospital-based registries. Based on the school survey, the prevalence of RF/RHD was estimated to be 143/100,000 population. In the registry, the annual incidence of acute RF was estimated to be at least 8.7/100 000 children in the age group of 5-14 years. The prevalence of GAS was 2% (13/656) in children with sore throat and 0.5% (14/2920) among those not having sore throat. Typing of 27 GAS revealed 16 emm types. We estimate that about 1000 episodes of GAS pharyngitis lead to one episode of acute RF.
  
  
  CONCLUSIONS
  RF/RHD continue to be a public health problem in Punjab, India.
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - Department of Cardiology.
authors.forename: Yash Paul
authors.initials: YP
authors.lastname: Sharma
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Jarnail S
authors.initials: JS
authors.lastname: Thakur
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Binod K
authors.initials: BK
authors.lastname: Patro
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Anju
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Inder P
authors.initials: IP
authors.lastname: Singh
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - School of Public Health.
authors.forename: Saroj Kumar
authors.initials: SK
authors.lastname: Rana
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - Department of Experimental Medicine and Biotechnology.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Chakraborti
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - Department of Experimental Medicine and Biotechnology.
authors.forename: Vanita
authors.initials: V
authors.lastname: Dhanda
authors.affiliation: Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India - Department of Experimental Medicine and Biotechnology.
authors.forename: Sunita
authors.initials: S
authors.lastname: Sapru
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Indian Council of Medical Research, New Delhi, India.
authors.forename: Bela
authors.initials: B
authors.lastname: Shah
authors.affiliation: National Institute of Immunology, New Delhi, India.
authors.forename: Nirmal K
authors.initials: NK
authors.lastname: Ganguly
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D010612:Pharyngitis / Q000453:epidemiology* / Q000382:microbiology*; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012213:Rheumatic Fever / Q000453:epidemiology* / Q000382:microbiology*; D012214:Rheumatic Heart Disease / Q000453:epidemiology* / Q000382:microbiology*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology*