Rheumatic fever is a serious illness, which in New Zealand most often affects school-aged children and young adults.
This section provides information about what the Ministry and the health sector are doing to address rheumatic fever, and provides links to information for health professionals.
14 Aug: Better Public Services
The Government has committed to delivering a set of ten Better Public Services results. One of these is to increase infant immunisation rates and reduce the incidence of rheumatic fever. Find out what the Ministry is doing to achieve this result.
25 May: Rheumatic fever programme expanded
The Ministry of Health’s Rheumatic Fever Prevention Programme is funding new health services, including school-based sore throat swabbing services, to help with the early detection of throat infections that can lead to this serious disease.
About rheumatic fever
The usual symptoms of rheumatic fever are:
- a warm, swollen painful joint (or joints)
- stomach pain
- sometimes a skin rash or lumps under the skin that aren’t itchy or painful
- sometimes jerky uncoordinated movements of hands, feet, tongue and face.
Rheumatic fever occurs when the body produces a strong immune response to a throat infection caused by a particular type of bacteria – Group A Streptococcus (‘strep throat’ or ‘GAS’ infection).
Most ‘strep throat’ infections get better without developing into rheumatic fever. However, in a small proportion of people, an untreated sore throat can cause the body’s defence mechanism (the immune system) to react very strongly, causing the heart, joints, brain and skin to become inflamed and swollen.
If this inflammation causes scarring on the heart valves the affected person can develop a condition known as rheumatic heart disease. Rheumatic heart disease can require heart valve replacement surgery, or even cause premature death.
Preventing rheumatic fever and rheumatic heart disease
Rheumatic fever can largely be prevented by antibiotic treatment of a streptococcal sore throat, to clear up the infection before it can develop into rheumatic fever. Presence of streptococcal bacteria can be confirmed by a throat swab (which a laboratory uses to test for the bacteria).
People who have had rheumatic fever need extra medical care for many years afterwards to prevent further damage to the heart. This includes 10 years of monthly penicillin injections and additional cardiology and dental care for those with rheumatic heart disease.
Rheumatic fever: an overview
Key facts relating to rheumatic fever in New Zealand include the following information.
- Approximately 160 cases of acute rheumatic fever, or 4.5 cases per 100,000 people, are diagnosed in New Zealand every year.
- School-aged Māori and Pacific children experience the highest rate of acute rheumatic fever.
- Rheumatic fever is most common in the North Island.
- There are significant clusters of rheumatic fever among school-aged children across Northland, South Auckland, Waikato, Bay of Plenty, Lakes, Tairawhiti, Hawke’s Bay, and East Porirua.
What is happening to address rheumatic fever?
The Ministry of Health is working to cut New Zealand’s incidence of rheumatic fever. The Ministry’s aim is that no ethnic groups or geographical communities should be disadvantaged with higher rates of rheumatic fever.
Key areas of work
Key areas of work that the Ministry and health sector are focusing on include:
- strengthening of frontline primary health care services,
- including community-based sore throat services to very high-risk populations (eg, school-based services)
- raising community awareness and improving health care worker training
- improving our surveillance, monitoring and research for rheumatic fever
- working with other sectors on factors that can contribute to throat infections and other infectious diseases (eg, housing).
What is being done in the priority regions?
The Ministry is implementing a $24 million five-year campaign to reduce rheumatic fever. The Rheumatic Fever Prevention Programme has focused on establishing school-based sore throat swabbing services in communities where rheumatic fever rates are high, including parts of Porirua, Northland, Hawke’s Bay, Bay of Plenty, Lakes District, Tairawhiti and South Auckland.
Under the programme children are assessed by health professionals for possible throat infection and where necessary followed-up with a course of antibiotics to stop bacteria developing. When fully implemented, more than 100 schools - with more than 35,000 children enrolled - will be involved in the swabbing programme, part of a $24 million five-year campaign to reduce rheumatic fever.
Other initiatives being implemented to support the sore throat swabbing include:
- a health promotion campaign to encourage families of children with sore throats to seek early treatment
- training for health professionals in high-risk areas to ensure that they recognise and respond appropriately to the signs and symptoms of ‘strep throat’ infections and rheumatic fever
- the development of a continuous quality improvement system and audit tools to enable general practices to evaluate and improve the quality of sore throat management with at-risk patients.
Rheumatic fever information for health professionals
Information and resources on rheumatic fever
The links on the right of this page provide information on rheumatic fever, including treatment guidelines, processes for notification of rheumatic fever, academic literature, guidance on how patients can access additional support, and links to other clinicians working in the area of rheumatic fever.
Notification of rheumatic fever
Rheumatic fever is a notifiable disease. All cases of rheumatic fever must therefore be notified to the local Medical Officer of Health.