Rheumatic fever

Rheumatic fever is a serious but preventable illness. It mainly affects Māori and Pacific children and young people (aged 4 to 19 years), especially if they have other family members who have had rheumatic fever.

Tofiga Fepulea'i: Talofa lava. My name is Tofiga and I’m here to talk to you about rheumatic fever.

I want you to know all about it. How it works and how you can avoid it, so that it doesn’t affect your children or your whānau.

[Video of Tofiga Fepulea’i standing in school grounds, talking to camera]

What is rheumatic fever?

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Tofiga Fepulea'i: Rheumatic fever is a serious disease that can affect your child’s heart. You can’t catch rheumatic fever. But you can catch the strep throat germs that can sometimes turn into rheumatic fever.

Sounds tricky? Let’s talk to someone who knows a whole lot more than I do.

[Video of Tofiga Fepulea’i standing within school grounds, talking to camera]

Dr Sarah Sciascia: Kia ora, my name is Doctor Sarah Sciascia. I’m a GP at Ora Toa Takapuwahia Medical Centre in Porirua.

Sore throats are common in children. Usually, a sore throat can be caused by a common cold or a flu and get better on its own.

[Video of Dr Sciascia in her clinic, talking to camera]

But strep throat is different. It needs to be treated with antibiotics straight away.

Rheumatic fever can develop from a strep throat if it’s not treated with antibiotics.

[Dr Sciascia voiceover. Video of children and mum heading towards the clinic in slow motion and being welcomed in by the nurse – children sit on the clinic bed]

Sometimes it can be hard to tell the difference

[Video close up of Dr Sciascia talking to camera]

between a common sore throat and a strep throat by just looking at it,

[Video cuts to close up of nurse’s hands as she puts on rubber gloves]

so get your child’s sore throat checked by a doctor or a nurse.

[Video close up of child getting a throat swab]

They may take a throat swab to test for the strep germs.

[Video close up of Dr Sciascia talking to camera]

How does strep throat turn into Rheumatic Fever?

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Dr Sarah Sciascia: In some young people – mostly aged between 4 and 19 – if a strep throat is not treated with antibiotics it can turn into rheumatic fever. This usually happens 1 to 5 weeks after your child has had a strep throat.

[Video of Dr Sciascia in the clinic talking to camera]

Dr Sarah Sciascia voiceover: What happens is, sometimes when the child’s body tries to kill the strep throat germs mistakenly it attacks other parts of the body too.

So the young person can have sore joints like their ankles, their knees and their hips. They can feel really tired.

And these are signs of rheumatic fever. It can sometimes go on to cause damage to the heart valves, which can lead to rheumatic heart disease – the next stage after rheumatic fever.

[Video shows animated diagram of strep throat germs going into the mouth and throat, then pulls back to show the full body with joints highlighted by red pulsing circles and a pulsing, damaged heart – the areas most affected by rheumatic fever and rheumatic heart disease]

Dr Sarah Sciascia: People with rheumatic heart disease may need heart surgery. Because of damage to the heart, rheumatic heart disease can sometimes lead to an early death.

[Video of Dr Sciascia in clinic, talking to camera]

How rheumatic fever affects your child and your whānāu

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Tofiga Fepulea'i: My family has been affected by rheumatic fever – my aunty got it when she was just a young girl.  And I hear stories.

Powerful stories. Like a young woman from this very community.

[Video close up of Tofiga Fepulea’i talking to camera]

Tofiga Fepulea'i voiceover: She’s 17 now, but when she was 9 she found out she had rheumatic fever.

Her joints were sore, she was really, really tired every day,

[Video cuts to close up of Tofiga and the young woman’s feet as they walk along the beach]

her feet got so sore she couldn’t even walk.

When she was told she went straight to the hospital and spent 8 months in bed. No playing, no out and about, you know it was a scary, hard time for the whole family.

When she was 10, things got a whole lot worse. The doctors said that she needed a heart valve transplant and she was flown straight to Starship hospital in Auckland.

[Video shots of Tofiga Fepulea’i walking along the beach with the young woman who shared her story]

Tofiga Fepulea'i: Since then she has had Penicillin injections once a month – and she still has a few years of this to go. She tells everyone, if your children have sore throats please get them checked.

[Video of Tofiga Fepulea’i in school grounds talking to camera]

Rheumatic fever is preventable

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Dr Sarah Sciascia: Rheumatic fever is preventable.

If your child is given antibiotics for a strep throat, they need to take them for the whole 10 days – even if they’re feeling better.

It takes 10 days to kill all the strep throat germs.

Tofiga Fepulea'i: Children can get strep throat more than once. Every time your child has a sore throat, please get it checked out, and if it is strep throat again, they will need antibiotics again.

And just like a cold or a flu, strep throat germs can be easily spread. So remember when coughing and sneezing cover your mouth and wash and dry your hands often, especially after coughing and sneezing.

[Video of Dr Sciascia and Tofiga Fepulea’i in the clinic. As doctor instructs to ‘cover your mouth’, ‘wash and dry hands’, Tofiga mimes the actions, then coughs into his elbow. He jokingly wipes the germs from his arm and sprinkles them over the doctor who reacts with a mock tap at Tofiga]

Text only: Tena Koe, Fa’afetai, Malo

Thank you for your support and help in developing this video.

  • Dr Sarah Sciascia and Tofiga Fepulea’i
  • Staff and community of Ora Toa Takapuwahia Medical Centre, Porirua
  • Parents and caregivers who tested the creative concepts
  • Young people who shared their stories

[Video text frame of acknowledgements – music track; no voiceover]

For more information about preventing rheumatic fever visit rheumaticfever.health.govt.nz

[Video endframe with url to visit, programme logo (Stop Sore Throats Hurting Hearts) and organisational logos (Ministry of Health and Health Promotional Agency) – music track; no voiceover]

Summary

Sore throats need to be checked

Rheumatic fever starts with a sore throat that is known as ‘strep throat’ – a throat infection caused by a bacteria called Group A Streptococcus.

Most sore throats get better on their own after about four days. But if strep throat is not treated with antibiotics it can cause rheumatic fever in at-risk children and young people. All sore throats in Māori and Pacific children and young people (aged 4–19 years) who are living in some parts of the North Island need to be checked.

If your child has strep throat, they’ll be given oral antibiotics for 10 days or a one-off penicillin injection to clear up the infection. It’s important to take the oral antibiotics for the full 10 days, even if they are feeling better. For more information, go to Sore throats.

About rheumatic fever

Rheumatic fever is an autoimmune disease. It happens when your child’s immune system makes a mistake and attacks other parts of your child’s body, as well as the strep throat germs.

Most strep throats get better and don't lead to rheumatic fever. However, in a small number of people, an untreated strep throat develops into rheumatic fever, where their heart, joints (elbows and knees), brain and skin become inflamed and swollen.

A strep throat infection can lead to rheumatic fever, even if it's the first time or a one-off. The risk of getting rheumatic fever gets higher when someone has repeated untreated strep throat infections.  

While the symptoms of rheumatic fever may disappear on their own, the inflammation from even one rheumatic fever attack could develop into rheumatic heart disease, where there is scarring of the heart valves. This is serious. But almost all cases of rheumatic fever, rheumatic heart disease and associated deaths are preventable.

If your child has rheumatic fever

If your child develops rheumatic fever they will need a lot of bed rest and time off school. They’ll need to stay in hospital for weeks, where they will have examinations and blood tests to check their condition.

Rheumatic fever can affect your child’s life, making it more difficult for them to play sport or do other activities as they will have less energy.

Rheumatic heart disease

If your child’s rheumatic fever develops into rheumatic heart disease, it could cause serious heart problems, damaging your child’s heart forever. Your child may need heart surgery.


Find out more from the Ministry

Information about what the Ministry and the health sector are doing to address rheumatic fever in New Zealand. – Rheumatic fever

Symptoms

Rheumatic fever usually starts 1–5 weeks after your child has had strep throat.

Your child may develop:

  • sore and swollen joints (knees, elbows, ankles and wrists). Joints may feel hot as well; different joints may be sore on different days
  • an ongoing fever that lasts a few days
  • rash over the elbows, wrists, knees, ankles, and spine
  • small lumps under the skin
  • unusual jerky movements of hands, feet, tongue and face.

If your child has these symptoms or signs take them to the doctor or nurse straight away to get them checked.

They may also have:

  • a fever at or greater than 38° C
  • stomach pains
  • weight loss
  • extreme tiredness.

While the symptoms of rheumatic fever may disappear on their own, the inflammation caused by one rheumatic fever attack could develop into rheumatic heart disease where there is scarring of the heart valves and your child may need heart surgery. Rheumatic heart disease can be life threatening and can damage your child’s heart forever.

Anyone suspected to have rheumatic fever should be admitted to hospital for a thorough assessment. 

The hospital will do some tests to confirm whether your child has rheumatic fever or not. The tests may include a blood test and ECG or echocardiogram.

Prevention

Because rheumatic fever starts with a sore throat, it’s important that your child’s sore throats get checked, especially if you live in Northland, Auckland, around Rotorua and Taupo, Waikato, the Bay of Plenty, Gisborne and the East Coast, Hawke’s Bay, Wellington or the Hutt Valley.

If your child is Māori or Pacific, aged between 4 and 19 years and has a sore throat, please get it checked straight away.

If your child has strep throat, they’ll be given antibiotics to clear up the infection before it can develop into rheumatic fever.

Where to get your child checked

There are lots of places you can get a sore throat checked.

  • You can go to your normal doctor or nurse. You may have to pay a fee; you can phone ahead to check. Let the receptionist know you have a child with a sore throat, just in case they have nurses available to respond quickly.
  • Your child’s school may have a free sore throat checking programme. Contact the school to find out.
  • You can also call Healthline on 0800 611 116 if you have any immediate concerns about your child’s sore throat.

If your child is given antibiotics, it’s important they take the full 10-day course, even if they feel better, to stop the sore throat turning into rheumatic fever.

Keep your home warm and dry

Keep your home warm and dry, and create as much space as possible to spread out around your home (rather than having to crowd in the same room).

Having more warm rooms and more sleeping spaces available means germs like strep throat are less likely to spread.

Go to Warmer, drier homes for tips that can make your home cheaper to heat and more comfortable to live in. Even following just a couple of tips will help protect your family from health problems.

Living with

Rheumatic fever has long-lasting consequences. Repeated attacks of rheumatic fever can make rheumatic heart disease worse.

To prevent more attacks of rheumatic fever that can lead to rheumatic heart disease, it is important to stop further strep throat infections. This is done by giving your child penicillin injections every 28 days for at least 10 years.

Your child will also need:

  • time off school and not be able to exercise or play sports until their body has recovered.
  • regular dental checks and extra care of teeth and gums
  • an annual flu vaccination as well as the regular immunisations. The flu vaccine is free for people who have had a heart disease, such as rheumatic fever. Immunisations are important for people who have had rheumatic fever to prevent other illnesses which could affect their heart health.

Dentist visits

Looking after teeth and gums is very important if someone has had rheumatic fever because they are at risk of developing an infection on their heart valves. So please tell any oral health professional (dentist, dental nurse, hygienist or therapist) or other health carer that your child has had rheumatic fever.

Some children may need antibiotics before having dental work done to help reduce the chance of any infection reaching their heart during the dental procedure. Talk to your child’s doctor or dentist for more information.

A diet low in sugar is important to prevent tooth decay.

Make sure your child brushes their teeth twice a day with regular strength fluoride toothpaste – in the morning and before going to bed at night.

Dental care is free for under 18 year olds. For over 18 years, contact your local district health board for information on what support is available for getting regular dental care.

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