70 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 27, NO. 2, 2014 Original Article Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India RAJESH KUMAR, JARNAIL S. THAKUR, BINOD K. PATRO, ANJU BHATIA, INDER P. SINGH, SAROJ KUMAR RANA School of Public Health YASH PAUL SHARMA Department of Cardiology ANURADHA CHAKRABORTI, VANITA DHANDA, SUNITA SAPRU Department of Experimental Medicine and Biotechnology Indian Council of Medical Research, New Delhi, India MEENAKSHI SHARMA, BELA SHAH National Institute of Immunology, New Delhi, India NIRMAL K. GANGULY Correspondence to YASH PAUL SHARMA; sharmayashpaul@yahoo.co,in © The National Medical Journal of India 2014 Streptococcal pharyngitis, rheumatic fever and rheumatic heart disease: Eight-year prospective surveillance in Rupnagar district of Punjab, India RAJESH KUMAR, YASH PAUL SHARMA, JARNAIL S. THAKUR, BINOD K. PATRO, ANJU BHATIA, INDER P. SINGH, SAROJ KUMAR RANA, ANURADHA CHAKRABORTI, VANITA DHANDA, SUNITA SAPRU, MEENAKSHI SHARMA, BELA SHAH, NIRMAL K. GANGULY 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 surveil- lance 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. Conclusion. RF/RHD continue to be a public health problem in Punjab, India. Natl Med J India 2014;27:70–5 INTRODUCTION Acute rheumatic fever (RF), initiated by group A streptococcal (GAS) throat infection, 1 often leads to chronic rheumatic heart disease (RHD). 2 The consequences of RF/RHD include damage to heart valves, repeated hospitalizations, increasing disability and premature death. In developed countries, RF/RHD are no longer a major public health concern, declining gradually as socioeconomic conditions improved. 3 However, children and adolescents in developing countries continue to be susceptible. Poor socioeconomic status particularly overcrowding contributes to the high prevalence of RF/RHD. 4 On the basis of a limited number of studies, Carapetis et al. estimated at least 15.6 million patients with RHD in the world with 282 000 new patients and 233 000 deaths each year . 5 Systematic reviews have identified only few population-based studies on RF/RHD from developing countries. 6 The prevalence is reported to be high in Africa and Asia. According to epidemiological surveys conducted in the second half of the 20th century, the prevalence of RHD in India varied from 1 to 11 per 1000 school-going children in the age group of 5–15 years. 7,8 Some investigators have opined that the prevalence of RF/RHD has been declining in India whereas others believe that there is no change. 9–12 Currently, global efforts for prevention of RHD rely on secondary prophylaxis, i.e. regular administration of antibiotics