Multi-country Evaluation of Early RHD in Children Across Africa for Vaccine Trial Readiness

A Multinational Cohort Study to Determine the Incidence of Early Rheumatic Heart Disease (MEERCATS Study 1)

This study will look at how many children develop rheumatic heart disease (RHD) over a 3-year period. The study will include children ages 5 to 8 who do not have RHD at the start and who live in areas where the disease is common. Each child will have a heart ultrasound (echocardiogram) once a year for 3 years to check for signs of RHD. Doctors will diagnose RHD using internationally recognized guidelines from the World Heart Federation (2023). The study will also look at how often new cases occur each year, whether rates differ by age, sex, or location, and whether any children develop acute rheumatic fever during the study.

Inclusion Criteria:

• Age 5-8 years at enrollment
• Residence within participating study catchment area
• Parent/guardian able to provide informed consent
• Participant able to provide assent where age-appropriate (country-specific, see below)
• Normal baseline echocardiogram according to study screening protocol

Exclusion Criteria:

• History of past ARF or RHD with or without cardiac involvement
• Evidence of RHD at baseline screening
• Congenital heart disease at baseline screening (excluding small PFO/ASD)
• Medical conditions that would preclude safe participation or follow-up
• Anticipated inability to complete study follow-up