Acute rheumatic fever and heart disease in regional NSW: risk, rates and recognition

Guest posting: Peter Massey and Julie Kohlhagen, Hunter New England Population Health. 

Much of the media and health service attention on Acute Rheumatic Fever (ARF) & Rheumatic Heart Disease (RHD) are rightly focused on the top end and desert communities in Australia. In a prospective screening survey of RHD in northern Australia Roberts et al (2015) reported that the prevalence of definite RHD differed between regions, from 4.7/1000 in Far North Queensland to 15.0/1000 in the Top End of the Northern Territory and the rates are comparable with figures from developing countries. But this does not mean ARF/RHD are not important diseases elsewhere in Australia.

Since ARF/RHD became notifiable in NSW two years ago there have been more than 60 cases of ARF and more than 50 cases of RHD notified in this state, many in regional NSW. As expected most cases are in Aboriginal children, and the disease is having a devastating impact on the children and families.

‘Primordial’ RHD prevention is about improving environmental, economic, social and behavioural conditions that are known to increase the risk of infections. Primary prevention includes the early diagnosis of group A Streptococcal throat and skin infections in people most at risk of ARF (typically children aged 5–14 years, Aboriginal people and Maori and Pacific Island people), and appropriate treatment with the correct antibiotics. Secondary prevention encompasses the early detection of disease and measures to prevent recurrent disease and worsening of the condition.

Key messages

  • ARF/RHD is impacting children and families in regional NSW and is 100% preventable.
  • Typical presenting symptoms of ARF include fever, malaise, one or more painful joints, unable to walk or use a limb, unusual movement (chorea)
  • Limb or joint pain in a school aged Aboriginal child should be assumed to be ARF until proven otherwise.
  • Aboriginal children, and children from high risk ethnic groups, with sore throat and/or skin infection need to be more carefully considered for antibiotics, more than for children from other groups
  • This Guidelines and diagnosis calculator app is a very useful resource
  • Information for patients

Do you have experience with diagnosing and treating ARF/RHD? What do you think will be the key issues to be working on together to reduce the rate and impact of ARF/RHD in regional areas?  Please email us with your perspectives and ideas –  Julie.Kohlhagen@hnehealth.nsw.gov.au .

Reference

Roberts, K.V., Maguire, G.P., Brown, A., Atkinson, D.N., Remenyi, B., Wheaton, G., Ilton, M. & Carapetis, J. 2015, “Rheumatic heart disease in Indigenous children in northern Australia: differences in prevalence and the challenges of screening”, The Medical journal of Australia, vol. 203, no. 5, pp. 221.e1.

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