Systematic Review: Estimation of global burden of non-suppurative sequelae of upper respiratory tract infection: rheumatic fever and post-streptococcal glomerulonephritis.

Objectives: To establish the incidence of post-streptococcal glomerulonephritis (PSGN) and acute rheumatic fever, the prevalence of rheumatic heart disease (RHD), and to estimate morbidity and mortality caused by these diseases globally.

Methods: Systematic literature review and review of World Health Organisation (WHO) vital registration data (VRD).

Results: Incidence and prevalence of rheumatic fever and RHD show very significant global variation. The greatest burden was found in sub-Saharan Africa, the lowest in North America. The highest mortality rates from these two diseases were reported in the indigenous populations of Australia (23.8 per 100,000). Among countries with VRD, the highest mortality was found in Mauritius (4.32 per 100,000). A few studies reported mortality from PSGN and these reported low mortality rates (mean 0.028 per 100,000 in developing countries).

Conclusion: Lack of data from key parts of the world limits our ability to make precise statements of disease burden. Further research and surveillance is required to generate more primary data to inform future estimates.