The Cairo Accord: Towards the eradication of RHD - an update (2025)

Abstract

Since the 2021 update of the Cairo Accord there has been considerable progress in addressing rheumatic heart disease through enhanced data collection, research, and global collaboration, however, these efforts remain insufficient, and significant challenges persist, underscoring the need for continued and intensified action.

Global databases and hospital-based registries, such as the Aswan Rheumatic Heart Disease Registry (ARGI), have enhanced understanding of RHD’s prevalence, progression, and treatment outcomes, supporting more targeted interventions. However, challenges with data quality and cause-of-death misclassification persist, highlighting the need for ongoing improvements.

Echocardiography remains a critical tool for screening, for which the updated diagnostic criteria include stage-based classifications and risk assessments. While screening programs have expanded, they often focus on schoolchildren, potentially missing cases in older youth and adults. Simplifying diagnostic protocols remains a priority for broader application.

Genetic research has advanced, with genome-wide association studies identifying new genetic loci associated with RHD in African and South Asian populations. Biomarkers for early diagnosis, such as cytokine profiles and autoantibodies, are being validated to improve detection and prognosis. These findings could inform personalized prevention and future vaccine development, addressing the underlying causes of susceptibility and disease progression. 

Vaccine development and innovations in secondary prevention, such as improved penicillin delivery, are progressing, though challenges like strain diversity and funding remain. The Cairo Accord also emphasizes regional Centers of Excellence, such as the Aswan Heart Centre, to integrate prevention, treatment, and research. Sustained funding, policy support, and international collaboration are essential to achieving the Accord’s goal of eradicating RHD.