Reply

We read with great interest the letter of Fairley JM, and Ahmad M and thank them for their interest and invaluable contribution to our paper. They pointed out the recent developments in 2019 about the screening and prophylaxis of rheumatic heart disease. We agree that simplified efficacious screening proposed by Remeydi et al, and Nunes et al for rheumatic heart disease would be very beneficial particularly in the resource-poor countries.^{Reference Remenyi, Davis and Draper1,Reference Nunes, Sable and Nascimento2} Especially, the study of Nunes et al is encouraging the applicability of 1-stage handheld echocardiographic screening without confirmatory follow-up.^{Reference Nunes, Sable and Nascimento2} Another important problem discussed by Fairley JM, and Ahmad M was the necessity of secondary penicillin prophylaxis in patients with borderline or latent rheumatic heart disease. Although our policy is close follow-up without secondary prophylaxis, the correct answer of this problem is not clear. We hope that the results of GOAL trial will help us to solve this problem.^{Reference Beaton, Okello and Engelman3} The criteria proposed by Nunes et al about prediction of disease progression is also very promising in respect to secondary prophylaxis in borderline rheumatic heart disease.^{Reference Nunes, Sable and Nascimento2}