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1497, poster, cat: 49 PREVALENCE OF EARLY RHEUMATIC HEART DISEASE IN RURAL GUYANESE AMERINDIAN CHILDREN AS DETECTED BY ECHOCARDIOGRAPHIC SCREENING S.N.L. Roth1,2, L. Aronson5, L. Craw1,4, F. Fernandes1,4, E. Koelink1,4, J. Longtin6, N. Musewe7, B. Ortuoste2, N.R. Saunders1,4, M. Silverman3 1 University of Toronto, Toronto, ON, Canada, 2The Scarborough Hospital, Toronto, ON, Canada, 3Lakeridge Health Centre, Oshawa, ON, Canada, 4Hospital for Sick Children, Toronto, ON, Canada, 5North York General Hospital, 6Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada, 7Markham Stouffville Hospital, Markham, ON, Canada Background: Cardiac auscultation has low sensitivity for diagnosing rheumatic heart disease (RHD) in children. No previous prevalence studies using echo Doppler (ED) to screen for RHD in children in the tropical Western Hemisphere exist. Objective: To determine the prevalence of early changes by ED in asymptomatic children compatible with RHD in the Amerindian population of rural Guyana. Methods: A Canadian medical team visited ten remote Amerindian villages in eastern and southern Guyana. Randomly selected healthy children underwent clinical examination and ED study using portable equipment. Two cardiologists using prespecified criteria reviewed all ED studies. If RHD findings were noted, a long-term penicillin supply for secondary prophylaxis was provided. A small subgroup of identified RHD cases (7) and ED negative age and sex matched controls (15) underwent throat swabs for PCR for Streptococcus pyogenes and Streptococcal serology (ASOT). Results: 228 children between the ages of 8 and 17 years were reviewed: Thirteen children had definite echo evidence for RHD (5.9%). Sixty-seven percent had evidence of recent streptococcal infection. The relative risk of cases versus controls of being PCR positive for Streptococcus pyogenes was 3.6 (p<0.05). Incidental findings included one case each of patent ductus arteriosus, bicuspid aortic valve, ventricular and atrial septal defect. Conclusions: Although sample size is small, this study suggests the highest prevalence of subclinical RHD worldwide and evidence of extremely high prevalence of streptococcal infection. Approaches to the local diagnosis and management of streptococcal pharyngitis need to be reassessed and appropriate treatment algorithms formulated to reduce RHD prevalence.