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2 Rheumatic and rheumatic disease from RHD CYAN MAGENTA YELLOW BLACK

Deaths from rheumatic heart disease ICELAND 2 Rheumatic fever and FINLAND Number of deaths SWEDEN NORWAY 2002 rheumatic heart disease ESTONIA RUSSIAN 10 000 and above 500–999 0–9 UNITED LATVIA FED. KINGDOM Rheumatic fever usually follows DENMARK LITHUANIA 5000–9999 100–499 no data an untreated beta-haemolytic IRELAND NETH. BELARUS POLAND streptococcal throat in BELGIUM GERMANY 1000–4999 10–99 CZECH UKRAINE REPUBLIC SLOVAKIA children. It can affect many parts LUX. REP. HUNGARY MOLDOVA AUSTRIA ROMANIA of the body, and may result in FRANCE SWITZ. SLOVENIA BOSNIA & S. MARINO HERZEGOVINA rheumatic heart disease, in which CANADA CROATIA SERBIA & BULGARIA RUSSIAN FEDERATION MONTENEGRO ANDORRA MONACO ITALY the heart valves are permanently If treated, ALBANIA PORTUGAL FYR MACEDONIA damaged, and which may progress 75% of people SPAIN to , atrial , with rheumatic GREECE fever recover KAZAKHSTAN and embolic . MALTA MONGOLIA completely. Nowadays, rheumatic fever U S A DPR GEORGIA UZBEKISTAN KYRGYZSTAN KOREA JAPAN ARMENIAAZERBAIJAN mostly affects children in TURKEY TURKMENISTAN REP. TAJIKISTAN KOREA developing countries, especially CYPRUS SYRIAN ARAB TUNISIA REPUBLIC CHINA MOROCCO LEBANON AFGHANISTAN where poverty is widespread. Up ISRAEL IRAQ ISL. REP. JORDAN IRAN MARSHALL ISLANDS to 1% of all schoolchildren in KUWAIT PAKISTAN BHUTAN KIRIBATI BAHAMAS ALGERIA LIBYAN NEPAL CUBA ARAB BAHRAIN QATAR Africa, Asia, the Eastern MEXICO JAMAHIRIYA NAURU EGYPT UAE BANGLADESH TUVALU Mediterranean region and Latin DOMINICAN SAUDI ARABIA INDIA JAMAICA REP. MYANMAR LAO BELIZE HAITI PDR SAMOA COOK MAURITANIA OMAN VIET NAM America show signs of the ST KITTS & NEVIS ANTIGUA & BARBUDA ISLANDS GUATEMALA HONDURAS MALI FIJI DOMINICA CAPE VERDE NIGER THAILAND VANUATU EL SALVADOR ST VINCENT & GRENADINES SENEGAL ERITREA YEMEN disease. ST LUCIA GAMBIA PHILIPPINES TONGA NIUE NICARAGUA BARBADOS CHAD SUDAN GRENADA CAMBODIA GUINEA-BISSAU BF Of 12 million people currently COSTA RICA TRINIDAD & TOBAGO DJIBOUTI GUINEA NIGERIA VENEZUELA PANAMA GUYANA CÔTE SRI LANKA SIERRA LEONE BENIN affected by rheumatic fever and ETHIOPIA PALAU SURINAME D’IVOIRE TOGO CENTRAL AFRICAN MALDIVES BRUNEI DAR. LIBERIA GHANA COLOMBIA REPUBLIC SOMALIA rheumatic heart disease, two- EQUATORIAL CAMEROON MALAYSIA GUINEA UGANDA MICRONESIA, thirds are children between KENYA SINGAPORE ECUADOR GABON FED. STATES OF SAO TOME SEYCHELLES & PRINCIPE DEM. REP. RWANDA 5 and 15 years of age. There are CONGO CONGO BURUNDI PAPUA around 300 000 deaths each year, PERU UNITED REP. INDONESIA NEW TANZANIA BRAZIL GUINEA SOLOMON ANGOLA COMOROS with two million people requiring TIMOR LESTE ISLANDS repeated hospitalization and one MALAWI ZAMBIA million likely to require surgery BOLIVIA MADAGASCAR ZIMBABWE MAURITIUS 1 008 207 NAMIBIA in the next 5 to 20 years. BOTSWANA MOZAMBIQUE Early treatment of CHILE PARAGUAY streptococcal can SWAZILAND AUSTRALIA LESOTHO preclude the development of SOUTH URUGUAY AFRICA rheumatic fever. Regular long- ARGENTINA 734 786 term treatment can prevent rheumatic fever becoming rheumatic heart NEW Deaths from rheumatic fever and ZEALAND disease, and can halt disease Rheumatic heart disease in children rheumatic heart disease in the Aboriginal progression in people whose heart Estimated number of cases in 5 to 14-year-olds and non-Aboriginal populations of Australia reported 2003 valves are already damaged by the 1979–1996 disease. In many developing countries, lack of awareness of Percentage of deaths these measures, coupled with Average age at death shortages of money and 94% 176 576 Aboriginal 36 years 136 971 153 679 resources, are important barriers population 101 822 to the control of the disease. non-Aboriginal 40 366 33 330 population 67 years 7744

6% Sub-Saharan China South-Central Asia Eastern Eastern Pacific Developed Africa Asia (other) Mediterranean Europe countries 20 and North Africa 21