Valvular Heart Disease in a Young Israeli Ethiopian Immigrant Population From the Gondar Region With Implications for Rheumatic Heart Disease

Abstract

BackgroundRheumatic heart disease (RHD) among Ethiopian school children was recently found to be 1.4%. Immigration of the Jewish population from the Gondar region to Israel created an opportunity for further enquiry.MethodsA cross-sectional study of the cardiac status of 113,671 adolescent recruits aged 16–19 years from the northern district of Israel who completed the medical profiling process over a 22-year period.Results140 recruits had a history of rheumatic fever (0.12%), although none from an Ethiopian origin (n = 1,719). The prevalence of valvular heart disease clinically and confirmed echocardiographically in Ethiopian recruits was not different from the total population (0.81 and 0.93%, respectively). However, the prevalence was higher in those migrating to Israel in their 13th year or older (2.09%), compared to those migrating at a younger age or born in Israel (0.49%).ConclusionThe Ethiopian teenage Israeli population from Gondar had a high rate of auscultation positive and echocardiographically confirmed valvular disease that suggested a high rate of RHD (~1.6%), despite no relevant past history. Our findings also suggested that for the younger Ethiopian immigrants or Israeli born subjects of Ethiopian origin, the improved medical care may well reduce the prevalence of valvular heart disease to that of the rest of the local population.

Health Challenges of the Pacific Region: Insights From History, Geography, Social Determinants, Genetics, and the Microbiome

“…Epidemiological studies have shown that socio-economic and environmental conditions, including access to healthcare systems, remain among the major determinants of ARF/RHD prevention (98–100). Moreover, several GAS strains identified as “rheumatogenic” were associated with ARF and differentially influence host immune response (101, 102).…”

Rheumatic Fever in Large Cohort of Adolescents in Israel

“…It has been shown to have a stringent, high quality medical process with reliable data (34). The study population consisted of consecutive conscripts 16-19 years old, born during 1971-1993 who completed the medical profiling process during the years 1988-2011 with valid height and weight measures as previously described (35,36).…”

“…Israel is a large mix of immigrants and locally born populations. Nevertheless, it is imperative to note that immigrants to Israel came from diverse countries and over the years of our study, mainly the FUSSR and Ethiopia (33,35), which vary in term of available medical services including diagnosis, monitoring, and treatment. There were no cases of ARF among the Ethiopian origin population of our study.…”

“…This might be due to a combination of under-diagnosis of those born in Ethiopia and relatively small sample size of those born in Israel. An estimate of RHD among the Israeli-Ethiopian born population has shown that rates are probably in the range of those common in Africa (35). Also, studies from Africa document high rates of RHD and very low rates of ARF (37-40), except in Sudan (41).…”