Children in American Samoa diagnosed with rheumatic heart disease are missing doses of a daily antibiotic that protects their hearts, and doctors say the consequences are serious.
Dr. Maria Gayapa of LBJ Tropical Medical Center says she is seeing children relapse after going without medication for more than three months. Some are coming to the clinic unable to walk and need wheelchairs due to severe joint pain caused by recurring acute rheumatic fever.
Department of Health program staff say most issued pill bottles are being returned half-full or completely untouched.
The antibiotic, oral penicillin, must be taken twice daily—every 12 hours—to keep children protected. Until recently, most patients received a longer-acting injection called Bicillin every three weeks. A national shortage that began in late 2023 forced most patients to switch to the daily pill.
The medication is free.
Dr. Gayapa says a common pattern among teenage patients is that parents tell their child to take the medicine rather than watching them take it. “Most of the time, once these children hit their teenage years, parents would just say ‘take your medicine’ rather than personally supervising the dose being taken,” she said.
Repeated episodes of acute rheumatic fever can damage the valves of the heart, leading to rheumatic heart disease, stroke, lifelong disability, or death.
Preliminary figures from a May 2026 screening of students at 16 schools across the territory show 72 students with RHD, including 57 newly identified cases.
Parents and caregivers are urged to watch their child take each dose and keep all scheduled clinic appointments. Free medication is available at DOH clinics and LBJ. Contact your nearest health center if your child has missed doses.
