How are we doing?

In the 12 months ending 30 June 2023, there were 138 people admitted to hospital for the first time with rheumatic fever (2.7 per 100,000) in New Zealand. This is an increase from 77 people in the 12 months ending 30 June 2022 (1.5 per 100,000). 

First episode rheumatic fever hospitalisations, annual rate per 100,000, New Zealand, 2006/7 – 2022/23

The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/7 to 2022/23 The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/7 to 2022/23 The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/7 to 2022/23

The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/07 to 2022/23.

The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/07 to 2022/23.

First episode rheumatic fever hospitalisations, annual rate per 100,000, by ethnic group, New Zealand, 2006/07 – 2022/23

First episode rheumatic fever hospitalisations, annual rate per 100,000, by ethnic group, New Zealand, 2006/07 – 2022/23 First episode rheumatic fever hospitalisations, annual rate per 100,000, by ethnic group, New Zealand, 2006/07 – 2022/23 First episode rheumatic fever hospitalisations, annual rate per 100,000, by ethnic group, New Zealand, 2006/07 – 2022/23

The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/07 to 2022/23 by ethnicity.

The graph above shows the rate of people admitted to hospital with rheumatic fever for the first time from calendar years 2006/07 to 2022/23 by ethnicity.

Following a decrease between years 2011 to 2016, there was a stabilisation in the rate of Māori admitted to hospital for the first time with rheumatic fever between 2016 and 2020. Since 2020, Māori rates have decreased from 8.7 per 100,000 (74 cases) in 2020 to 5.5 per 100,000 (49 cases) in 2022 (5.5 per 100,000). This represents an approximately 34% decrease in cases since 2020. However there has been an increase in rates to 7.0 per 100,000 (63 cases) in the year ending 30 June 2023.

Hospitalisations for Pacific people fluctuated between 2011 and 2019, however there has been a large decrease in Pacific people admitted to hospital for the first time with rheumatic fever since 2020. Since 2020, Pacific rates have decreased from 19.5 per 100,000 (69 cases) in 2020 to 8.2 per 100,000 (30 cases) in 2022. This represents an approximately 57% decrease in cases since 2020. This decrease has been largely driven by a reduction in hospitalisations for Pacific people in Counties Manukau. However, there has been an increase in rates to 18.6 per 100,000 (69 cases) in the year ending 30 June 2023.

Work is currently underway to understand the contributing factors that have led to this decrease and then observed increase recently. Specifically, it is crucial to understand if this is a true decrease or under-ascertainment due to reduced access to acute care associated with the COVID-19 pandemic and response. In addition, it is important to identify any factors working well at present in rheumatic fever prevention, that can be sustained going forward.

It is not surprising to see an increase in rheumatic fever hospitalisations, given what has occurred with other childhood respiratory infections (viral, invasive pneumococcal disease etc.) during the pandemic, with infection rates initially falling then now rising again. Te Whatu Ora will continue to watch the situation closely.

It is also important to note that while Aotearoa has a high incidence of rheumatic fever, the annual numbers are small compared to other illnesses. Therefore, changes year-to-year may be real, or they may be an artifact of the variability that is seen when there are small numbers of cases.

The following table shows the numbers and rates of people being admitted to hospital with rheumatic fever for the first time in 2022/23 by age group. It shows that the majority of cases continue to occur in children between 5 and 14 years.

First episode rheumatic fever hospitalisations, rate per 100,000, by age group, 2022/23

The table below details the rheumatic fever rates in 2022/23 by age group.

 

Numbers

Rate per 100,000

0–4 years

1

0.3

5–14 years

85

13.1

15–24 years

28

4.4

25–44 years

21

1.5

45+ years

2

0.1

First episode rheumatic fever hospitalisations, rate per 100,000, by Health District, 2022/23

The table below details the rheumatic fever rates in 2022/23 by health districts.

Health District

(formerly DHB region)

Numbers

Rate per 100,000

Northland

5

2.5

Waitemata

9

1.4

Auckland

13

2.7

Counties Manukau

61

10.1

Waikato

8

1.8

Lakes

<4

-

Bay of Plenty

10

3.6

Hauora Tairāwhiti

4

7.7

Taranaki

<4

-

Hawke’s Bay

<4

-

Midcentral

<4

-

Whanganui

0

0.0

Capital & Coast

6

1.9

Hutt Valley

7

4.3

Wairarapa

<4

-

Southern region

<4

-

Source: National Minimum Dataset

Note: Rates have not been calculated where there were fewer than four cases. This is because the small numbers will result in unreliable estimates of rates.

Where to from here?

A five-year Rheumatic Fever Roadmap was launched in June 2023. The purpose of the Roadmap is to reset and refocus efforts around rheumatic fever and rheumatic heart disease prevention, identification and management, and sets out existing and new priority actions and opportunities for investment in the coming years. 

 

The three focus areas of the Roadmap include:

  1. Whānau Ora – determinants of wellbeing and primary prevention.
  2. Tāngata Ora – quality health care and improved journey through the health system for those with rheumatic heart disease and rheumatic fever.
  3. Kōkiri Ngātahi – system readiness and change.

 

The Roadmap is available below.

Download: Rheumatic Fever Report 2022/23 - XLSX, 585 KB

Rates and numbers are available for the New Zealand population, by ethnic group and for district health board.

Download: Rheumatic Fever Roadmap, 2023 - 2028 - PDF, 9.3 MB

The Rheumatic Fever Roadmap, 2023 – 2028 has been developed to reset, renew and amplify efforts in Aotearoa New Zealand to tackle rheumatic fever.