Summary

Acute rheumatic fever (ARF) refers to an autoimmune response to infection of the upper respiratory tract (and possibly of the skin (McDonald, et al 2004)) by group A streptococcus (GAS) bacteria. ARF can affect the heart, joints, brain and subcutaneous tissues (Parnaby & Carapetis 2010). While there is no lasting damage caused to the brain, joints or skin, ARF may cause lasting damage to the heart.

Rheumatic heart disease (RHD) is caused by damage to heart valves as a result of repeated ARF episodes. An affected heart valve may become scarred and stiffer, obstructing blood flow (stenosis), or it may fail to close properly, causing blood to flow backwards in the heart instead of forward around the body (regurgitation). Regurgitation due to damage to the mitral valve is the most common symptom of RHD.

Jurisdictional RHD control programs and registers

Under the Rheumatic Fever Strategy, the Australian Government provides funding to support RHD control programs in 4 jurisdictions: Queensland (Qld), Western Australia (WA), South Australia (SA) and the Northern Territory (NT). These programs:

  • identify people with or at risk of ARF and RHD
  • promote primary prevention of ARF
  • support the delivery of long-term secondary prevention treatment
  • increase awareness of ARF and RHD among health professionals, and provide education about these diseases to health professionals, patients and their families and communities
  • maintain disease registers for people diagnosed with ARF or RHD, and use this information to monitor health outcomes and improve control program activities.

Acute Rheumatic Fever

In 2013–2017, there were 1,897 diagnoses of ARF recorded, a rate of 4 per 100,000 population. Each year from 2013 to 2017, the number and rate of diagnoses increased. In 2017, 528 cases were diagnosed, a rate of 6 per 100,000 population, increasing from 3 per 100,000 population in 2013.

The most common age at diagnosis was 5–14 years, with 964 diagnoses (16 per 100,000 population). ARF was more common in females than males, with 56% of diagnoses (1,060) occurring in females. Ninety-four per cent of ARF diagnoses (1,776) in 2013–2017 were in Aboriginal and/or Torres Strait Islander Australians.

Acute rheumatic fever among Indigenous Australians

In 2013–2017, there were 1,776 diagnoses, a rate of 85 per 100,000 population, for ARF among Indigenous Australians. A higher rate of ARF diagnoses was recorded for Indigenous females (1,006 diagnoses, 96 per 100,000) than males (770 diagnoses, 74 per 100,000) and for the age group 5 to 14 (602 diagnoses, 195 per 100,000).

Numbers and rates of ARF amongst Indigenous Australians during 2013–2017 were consistently highest in the NT. Fifty-three per cent (954) of all diagnoses were from NT. 

Rheumatic heart disease

As at 31 December 2017, there were 4,259 living RHD cases recorded on state and territory registers. Eighty–seven per cent of people with RHD were Indigenous Australians (3,690 diagnoses). NT has the greatest number of RHD cases and the most common age group at diagnosis was 15–24 years, with 941 diagnoses (22%). Two-thirds of people living with RHD (65%, 2,787 diagnoses) were females.

Rheumatic heart disease among Indigenous Australians

In 2013–2017, there were 1,043 RHD diagnoses among Indigenous Australians, a rate of 50 per 100,000 population. The NT had the highest rate and greatest number of new RHD diagnoses among Indigenous Australians. The rate for Indigenous females was around two times the rate for Indigenous males and nearly 60% of new RHD cases were less than 25 years old at diagnosis.

Secondary prophylaxis

Secondary prophylaxis with regular benzathine penicillin G (BPG) is the only RHD control strategy shown to be both clinically and cost effective at community and individual levels (RHD Australia, 2012). The recommended regimen to prevent recurrences of ARF and progression of RHD involves regular intramuscular injections of BPG every 21 to 28 days, for a minimum of 10 years.

In 2017, among Indigenous people:

  • 15% (394 people) received 100% or more of their prescribed doses
  •  21% (548 people) received 80% to 99% of their prescribed doses
  •  37% (964 people) received 50% to 79% of their prescribed doses
  •  28% (724 people) received less than 50% of their prescribed doses.