Rheumatic fever

Rheumatic fever is a serious illness, which in New Zealand most often affects Māori and Pacific children and young adults, aged 4–19 years.

This section provides information about what is being done by the Ministry, through its Rheumatic Fever Prevention Programme (RFPP), and by the health sector to address rheumatic fever. It also provides links to information for health professionals.

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What is rheumatic fever?

Rheumatic fever can develop after a ‘strep throat’ – a throat infection caused by a Group A Streptococcus (GAS) bacteria.

Most strep throats get better and don't lead to rheumatic fever. However, in a small number of people an untreated strep throat leads to rheumatic fever one to five weeks after a sore throat. This can cause the heart, joints, brain and skin to become inflamed and swollen.

While the symptoms of rheumatic fever may disappear on their own, the inflammation can cause rheumatic heart disease, where there is scarring of the heart valves.

People with rheumatic heart disease may need heart valve replacement surgery. Rheumatic heart disease can cause premature death in adults.

In 2014, 153 people were admitted to hospital for the first time with rheumatic fever.

Who gets rheumatic fever in New Zealand?

Māori and Pacific children and young adults (aged 4-19 years) have the highest rates of rheumatic fever. Māori children are about 20 times more likely to be hospitalised for rheumatic fever and Pacific children about 40 times more likely than non-Māori/non-Pacific children.

It is highly likely that a combination of crowded housing conditions and socio-economic deprivation, barriers to primary healthcare access and the subsequent higher burden of untreated strep sore throat infections are important factors leading to higher rates of rheumatic fever among Māori and Pacific people.

Rheumatic fever is unevenly distributed in New Zealand, with most cases recorded in the North Island.

What is happening to address rheumatic fever?

The Ministry of Health is working with other government agencies, health organisations, community and philanthropic groups, researchers and professional bodies to reduce New Zealand’s rheumatic fever rate.

The Ministry’s Rheumatic Fever Prevention Programme (RFPP) was established in 2011 to prevent and treat strep throat infections, which can lead to rheumatic fever. The Programme was expanded significantly from 2012 following the introduction of the rheumatic fever Better Public Services (BPS) target. The government has invested over $65 million to identify and trial new initiatives to reduce the rheumatic fever rates throughout New Zealand.

The Programme is working in the 11 District Health Board (DHB) areas with the highest incidence of rheumatic fever hospital admissions – Northland, Auckland, Counties Manukau, Waitemata, Waikato, Bay of Plenty, Tairāwhiti, Lakes, Hawke’s Bay, Hutt Valley and Capital & Coast DHBs.  High incidence DHBs are defined as those with three-year average baseline (2009/10 to 2011/12) incidence rates higher than 1.5 first episode rheumatic fever hospitalisations per 100,000 total population and a three-year average of four or more cases per annum.

The RFPP has three key strategies to reduce rheumatic fever:

  • Stakeholder engagement to increase prioritisation of rheumatic fever prevention and awareness raising of the importance of preventing and checking sore throats
  • Increase awareness of rheumatic fever, what causes it and how to prevent it
  • Reduce household crowding and therefore reduce household transmission of strep throat bacteria within households.
  • Improve access to timely and effective treatment for strep throat infections in priority communities.
Current RFPP initiatives Description
Improve access to timely treatment for strep throat infections among priority communities
Rapid response services Rheumatic fever can be prevented by prompt diagnosis of a strep throat infection and treatment with antibiotics. Rapid response services make it easier for children and young people to get their sore throats checked and treated if necessary by providing family-friendly access to free, sore throat services in high incidence areas. Rapid response services are already in Northland, Auckland, Waikato, Lakes, Bay of Plenty, Gisborne/East Coast, Porirua and Hutt Valley areas. Further  services are being  expanded into Hawke’s Bay over the coming months.
School-based programme This programme offers free sore throat assessment and treatment in more than 200 North Island schools in high incidence areas to about 50,000 children.
Best Practice for Sore Throat Management in Primary Care This project aims to improve the quality of sore throat management in primary care by:
  • raising primary care practitioner awareness of best practice
  • establishing ongoing quality improvement for the management of sore throats in high-risk individuals
Clinical audit/review processes will be encouraged across all services managing sore throats to monitor the impact of the project initiatives.
Antibiotic adherence in the primary prevention of rheumatic fever: It's important that people complete the full course of antibiotics prescribed to treat strep throat infections. The Antibiotic Adherence project aims to identify and roll out initiatives that will help primary care practitioners work with families of high-risk children to make sure antibiotics are taken appropriately. These initiatives will be trialled and those with the best results will be implemented across the programme in 2015.
Increase awareness of rheumatic fever, what causes it and how to prevent it
Communications campaigns The 2015 Rheumatic Fever Awareness Campaign was launched on 28 April 2015 and runs until August 29 across a range of marketing channels.  It builds on the 2014 Winter Rheumatic Fever Awareness Campaign which ran from May to August 2014 and will again be targeting Māori and Pacific parents and caregivers of at-risk Māori and Pacific children and young people.
An awareness campaign aimed at Māori and Pacific youth aged 13–19 years is being  rolled out, initially in Auckland and Northland. It includes youth ambassadors, social media, theatre in schools, development of short films on prevention and involvement in a range of youth events. The campaign is jointly designed and delivered by the Ministry of Health, Ministry of Youth Development and the Ministry of Pacific Island Affairs.
Pacific engagement service A Pacific engagement service in Auckland and Wellington which provides face-to-face awareness raising and education for Pacific families on the importance of getting sore throats checked and the link between strep throat and rheumatic fever. It is delivered by existing Pacific health providers already making health visits to homes and in community sessions.
Community Innovations Fund In 2014/15, one-off funding was provided through the Pacific Community Innovations Fund to support Pacific community groups to create and put into action their own ideas to improve awareness and help to reduce rheumatic fever. In 2015/16, the community innovations fund will focus on Māori-led initiatives.
Online learning An e-learning resource for health workers is currently under development.
Reduce household crowding and household transmission of strep throat bacteria
Healthy homes initiatives Healthy homes initiatives systematically identify families with children at risk of getting rheumatic fever who are living in crowded households and facilitate access to a range of interventions to reduce that crowding. The first of these initiatives was in Auckland and services have now been  expanded to Northland, Waikato, Wellington, Lakes, Bay of Plenty, Hawke’s Bay and Tairāwhiti DHB regions.
Social housing fast track scheme This Ministry of Social Development-administered programme addresses the impact that poor housing and crowded conditions have on the rate of rheumatic fever. The scheme aims to give families with children at-risk of rheumatic fever priority for appropriately sized state homes.

District Health Board rheumatic fever prevention plans

Each of the 11 DHBs in high incidence areas has a rheumatic fever prevention plan outlining how it intends to reduce rheumatic fever. We’ve provided links to the DHB plans available online.

From 1 July 2017, the government will invest ongoing funding of $5 million a year to continue with proven rheumatic fever prevention initiatives.  High incidence DHBs are refreshing their rheumatic fever prevention plans, with guidance from the programme, to ensure a smooth transition to business as usual.  Prevention plans will take into account all new evidence and evaluation data that has become available from the trials and new approaches that the programme has undertaken.

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