What it is?

Rheumatic Heart Disease is a preventable disease that kills more than 60 Fijians each year.It is the most common acquired heart disease in children in Fiji, with those aged between 5 and 15 considered most at risk.

Rheumatic Heart Disease is a chronic heart condition caused by Rheumatic Fever, which can develop following a Group A Streptococcal (Strep) infection. The main symptom of a Strep infection in a child is a sore throat. Each year, one in seven school children in Fiji will develop Strep throat.

Treating a Strep throat with antibiotics prevents a Strep infection from developing into Rheumatic Fever. If the Strep infection has developed into Rheumatic Fever, regular antibiotic injections over a period of time may prevent development of damage to the heart and can prevent any further damage to the heart.

Children With Sore Throat. What do I do? Could it be Strep?

My child has a sore throat. Could it be Strep?
If a child has a sore throat, it might be caused by a Group A Streptococcal infection, often referred to as ‘Strep throat.’ This kind of infection is most common in children aged 5 to 15, but can affect anyone.
If your child has Strep throat, they may find it difficult to swallow or eat food. The glands on their neck may be larger than normal, and they may have spots on their tonsils.

Only a doctor or nurse can tell if your child’s sore throat is Strep throat, and the only way to prevent Strep throat from potentially developing into Rheumatic Fever is to treat it with antibiotics.

My child has a sore throat. What do I do?
If your child has a sore throat, take them to a doctor or nurse and ask about Strep throat.
If the doctor or nurse thinks it is Strep throat, they will give your child one injection of Penicillin or a 10-day course of antibiotic tablets or mixture.
These antibiotics are free at Ministry of Health clinics.
The antibiotic tablets or mixture must be started straight away and taken for 10 days to prevent Rheumatic Fever, even if the sore throat goes away.
The doctor will say if it is not Strep throat.

What Happens if my child have Rheumatic Fever? What do I do?

How Can I tell if My Child Has Rheumatic Fever?
There are several symptoms with Rheumatic Fever. Your child may display many of the symptoms, or just one.
Symptoms can include:

  • sore or swollen joints (knees, elbows, ankles, shoulders and wrists)
  • skin rash, or spots on the skin
  • painless lumps under the skin (over bony parts)
  • fever
  • tiredness
  • jerky or uncontrolled movements, worsening writing or dropping things (chorea)
  • shortness of breath
  • chest pain (in severe RHD)

In around 40-60 % of cases, Rheumatic Fever causes damage to the heart valves. Though most symptoms of Rheumatic Fever will get better, any damage to the heart will be long-term and may worsen with further attacks of Rheumatic Fever.

How Does Rheumatic Fever Affect the Heart?
When Rheumatic Fever causes damage to the valves of the heart, this is called Rheumatic Heart Disease.

A heart valve acts like a one-way door. It makes sure that blood pumped by the heart flows in one direction only. When the heart valve is damaged, the heart cannot pump properly. This can cause breathlessness, tiredness and chest pain.

Each time a person gets Rheumatic Fever, the risk of damage to their heart increases. If their heart valve is damaged from an earlier attack, then the damage may get worse with subsequent attacks.

I think my child has Rheumatic Fever. What do I do?
If you think your child or anyone you know has Rheumatic Fever, you must take them to the hospital where they will be admitted to have their blood tested and their heart checked.

What happens if they do have Rheumatic Fever?
If a person has Rheumatic Fever, they will need three- or four-weekly antibiotic injections for at least ten years to prevent them from further attacks. This may seem like a long time, but if they do not have these injections they could have another attack of Rheumatic Fever, which could cause long-term damage to their heart.

People with Rheumatic Fever need a health check every year to keep them well, and regular heart scans. Regular heart scans are important as damage to the heart may only show up years after the first attack.

I think my child might have had Rheumatic Fever. Could their heart be damaged?
One in 50 school children in Fiji have Rheumatic Heart Disease, yet most don’t know they have it. This means most people with Rheumatic Heart Disease come to the hospital too late, when their heart is already failing.

One in ten people with Rheumatic Heart Disease will die within the first six months of them being diagnosed with the disease.

If you think your child may have had Rheumatic Fever but wasn’t checked by a doctor, you should make an appointment with the hospital to have a check. Your doctor will advise you if your child needs a heart scan or other tests.

What Happens if My Child Has Rheumatic Heart Disease?

If someone has Rheumatic Heart Disease, they will need regular check-ups and scans of their heart. They will also need three- or four-weekly Penicillin shots to prevent any further rheumatic fever and damage to their heart.

If the damage to their heart is very bad, they will need other medicines to help their heart and may need surgery to repair or replace the damaged heart valve.

My Child Has Already Had StrepThroat. Are they immune?

There is no immunity and no vaccinations for Strep throat or Rheumatic Fever. This means that your child could get Strep throat more than once, each time putting them at risk of developing Rheumatic Fever.

People who have had Rheumatic Fever once are at a higher risk of getting it again. This is why it is very important to ensure they have regular antibiotic injections to prevent them from any more attacks.

How Can I Prevent My Child from Getting Strep Throat?

Strep throat is very contagious. This means it can be passed from person to person.

The best way to stop Strep throat from spreading is to:

  • teach your child to tell you when they have a sore throat (then take them to the clinic to be seen)
  • teach your child to cover their nose and mouth when coughing or sneezing (preferably into their sleeve)
  • make sure your child washes and dries their hands after coughing and sneezing, before eating, and after going to the toilet.

RHD patient support groups

The RHD Prevention and Control Programme understands the importance of patient and carer support.  To be living with RHD means to be living with a long term chronic condition that requires regular visits to the hospital or health centre for monthly injections.  For some this can be a difficult and isolating journey. In the past few months the RHD programme has been working with health centres in the Suva sub-division, Ba and Nadi sub divisions to run patient support groups.  This is a great opportunity for patients to meet each other, tell their stories, learn from each other and learn more about the disease they are living with.

If you are living with RHD and are interested in getting involved please contact the RHD programme directly on: Phone – 3319348 or Email