An entirely preventable condition that causes severe and irreversible heart damage in Indigenous children may be transmitted through a reservoir of bacteria in the throat, according to Australian researchers. This discovery is expected to have implications for the prevention of rheumatic heart disease (RHD) and the development of vaccines, say infectious diseases physicians. RHD is a chronic and severe disease that primarily affects disadvantaged areas of low- and middle-income countries. Australia has one of the highest reported rates of RHD in the world, with cases found only in remote Indigenous communities facing social disadvantage. Indigenous children in these communities are particularly vulnerable to RHD and often require open-heart surgery. RHD is caused by infection with the highly contagious group A streptococcus bacterium, which also causes strep throat and skin infections. Most people, especially children, receive prompt treatment with antibiotics for strep throat. However, Indigenous children living in remote communities often experience repeated and untreated strep A infections due to overcrowding, poverty, and limited access to healthcare. These chronic infections can develop into acute rheumatic fever, which can lead to irreversible heart damage known as RHD. Without open-heart surgery to repair or replace damaged heart valves, sufferers can experience clot formation and may die from stroke or heart failure. To understand why rates of RHD in Australia have not decreased, researchers at the Doherty Institute in Melbourne analyzed the genetic makeup of hundreds of strep A bacterial samples collected between 2003 and 2005 from Aboriginal households in three remote communities in the Northern Territory. The researchers used whole genome sequencing, which was not available at the time of sample collection. They found that the strep A bacteria in the throats of individuals with no symptoms were the same as those found in people with skin infections and symptomatic disease. Researchers believe that skin-to-skin transmission of strep A, exacerbated by overcrowded living conditions, contributes to the spread of the disease in Aboriginal communities. Therefore, prevention efforts should focus on treating skin disease and sore throats. According to Dr. Michael Marks from the London School of Hygiene & Tropical Medicine, the study’s findings highlight the role of both skin and throat infections in the spread of the bacteria, with throat infections, even if asymptomatic, playing a significant role. Currently, there is no targeted vaccine for RHD; however, Prof. Andrew Steer from the Royal Children’s hospital in Melbourne is working on developing a vaccine for strep A. The study emphasizes the need to measure asymptomatic throat colonization of strep A in vaccine trials to effectively combat RHD.
Researchers find that throat bacteria may contribute to the spread of rheumatic heart disease in Indigenous children in Australia
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