Table 1 Rheumatic heart disease severity grading and indication for secondary prophylaxis [13]

Low risk

History of acute rheumatic fever with no evidence of rheumatic heart disease OR trivial to mild valvular disease.

Min 10 yrs after episode of ARF or age 21, whichever is longer

Medium risk

Moderate valve lesion in the absence of symptoms and with normal left ventricular function OR mechanical prosthetic valves.

Until age 35

High risk

Severe valvular disease OR moderate/severe valvular lesion with symptoms OR tissue prosthetic valves and valve repairs.

Until age 40, or longer if ongoing exposure to GAS remains high and risk also considered very high