Prevention of rheumatic fever

Because it is recognized communication rheumatism with streptococcal infection, then it is natural to take a principled framework for prevention of diseases, first of all, strengthening the natural immunity against infection in General and streptococcal in particular and, secondly, the decrease in the intensity strep exposure (strep environment) and the fight against streptococcal diseases. There are warning of rheumatism among healthy people, or primary prevention, and the prevention of relapses of the disease, or secondary prevention. Prevention of disease consists of three main parts. 1. Social and recreational activities of the state aimed at the education of a high level of natural immunity in the General population and especially among children, which is provided by the increasing economic and cultural level of people's life. This includes good nutrition, good living conditions, sanitary-and-hygienic mode of employment, improvement of professional adverse conditions, the reduction of working hours and extension activities; development of a wide network of health resorts, rest homes, sanatoriums; creation of conditions for wide development of physical culture and sports, tourism, travel, and others, with the maximum involvement of children; detailed construction of new schools, hospitals, clinics, health resorts, pioneer camps, forestry schools; pollution of air and water in cities and major towns; other measures to ensure harmonious combination of physical, intellectual, and moral factors in work. This group includes all other government measures to increase the level of health services (hospitals and clinics with qualified and free medical care, resorts and sanatoriums), as well as training of medical staff.
2. Activities of a public nature - using the party, Komsomol, trade unions, scientific and public organizations, print, radio, television, the red cross and red Crescent societies, committees of health and healthy life at Executive committees, the house administration and others in the creation of a high level of sanitation and hygiene in the workplace and in the home, in the popularization of scientific knowledge about rheumatism, its causes and prevention, etc.
3. Individual measures to prevent the onset, recurrence and hygienic lifestyle, leisure and employment; individual measures for prevention of streptococcal infections and their timely treatment, physical culture, sports, tourism, moderate physical labour, elimination of harmful habits (alcohol, Smoking), fighting in self and others
The success of the system of prophylaxis of rheumatic fever, both primary and secondary, is purposeful combining measures of socio-state, public and private. In the practical implementation of this system is a big and important role belongs to the organizers health, physicians and pediatricians.
For rheumatism most characteristic tendency to relapse, which most often occur in spring and autumn, in the period of the most frequent seasonal catarrh of the upper respiratory tract, angina and acute exacerbations of chronic tonsillitis. In this regard, in the USSR, on the recommendation of the Institute of rheumatism adopted a system of prevention of recurrence of rheumatic fever in spring and autumn in the form of a six-week course for drug prevention. It consists of a weekly injection bicillin 600 000 UNITS and daily intake for 6 weeks acetylsalicylic acid 1.5-2.0 g or amidopirina to 1,0-1,25 g, or butadiona 0.3, Such prophylaxis reduces the number of relapses of the disease in 2-3 times and more, reduction of angina in 3-5 times, and catarrh of the upper respiratory tract several times compared with the groups of patients with rheumatism, who did not receive such prevention. The same seasonal bicillin-prophylaxis recommended and the so-called threatened by rheumatism, ie and young people of school age suffering from chronic, often escalating nasopharyngeal infection that causes symptoms of consilierilor syndrome or threat of a truly rheumatic diseases. Numerous experiments established that the application of bicillin in such a system leads to progressive reduction of carriage of Streptococcus patients with rheumatism, to reduction of its pathogenic properties and is not accompanied by the appearance of penicillinonline strains of Streptococcus.
Due to relatively low doses of penicillin, as a rule, there is no safety risk for candidiasis and only rarely (1 - 2%) are detected Allergy symptoms (fever, skin itching, urticaria, and so on) and even rarer phenomenon of anaphylactic shock. Therefore, all patients who are assigned to the described system of prevention of the recurrence of diseases, should be carefully assembled history in order to identify formerly intolerance penicillin. If these symptoms appear after the first weekly injections bicillin, it should give up and start using penicillin-V (300 000 IU a day inside), or tetracycline antibiotics in appropriate dose (for example, 500 000 IU a day). Bicillin-drug prevention of rheumatism in the cardiological clinic or in the office - all should be prepared in case of an anaphylactic shock. Institute of rheumatism AMS of the USSR issued a relevant instruction to combat penicillin anaphylactic shock. If in the period between seasonal courses of bicillin-drug prevention arise signs of exacerbation of chronic foci of infection, nasopharyngeal Qatar or flu, the patient should undergo interseasonal re bicillin-drug prevention. If a patient with rheumatoid arthritis symptoms of acute streptococcal infection (sore throat, and others) who expert Committee (1957) recommends the following regimen (table. 3).

Table 3. Treatment of streptococcal infections
Drug Dose and duration of treatment Route of administration
Benzylpenicillin 250 000 IU 3 times a day for 10 days Inside
Phenoxymethylpenicillin (penicillin-V) About half dose of penicillin G Inside
Benzatin-penicillin or indepen 1 200 000 IU once or 600 000 IU twice for 10 days Intramuscularly
Tetracycline 0.5 g 4 times a day for 10 days Inside

Recently in the USSR began to apply a new Soviet drug penicillin prolonged action - bi-cillin-5, which you can enter by 1 500 000 UNIT 1 in 4 weeks or a month. If this prevention to be effective, it is advisable to go for year-round baselineprotection the recurrence of diseases at a rate of 1 500 000 UNITS 1 time per month and 12 times a year (children dose varies depending on age). Great experience of domestic and foreign doctors confirmed the feasibility of penicillin-for drug prevention for five consecutive years, especially in children.
Methodological centers on the organization of treatment and preventive care of patients with rheumatism in the USSR are cardiological clinics (Moscow, Leningrad, Kiev, Tbilisi, Dnepropetrovsk, Kharkov and other), cardiological centers, cardiological rooms at hospitals and clinics for adults and rheumatic rooms for children.
The functions of the scientific-organizational center and head of the research Institute on the problem of rheumatism in the USSR performs Institute rheumatism AMS of the USSR, established in Moscow in 1958