Acute rheumatic fever (ARF) refers to an autoimmune response to infection of the upper respiratory tract (and possibly of the skin) by group A streptococcus (GAS) bacteria. ARF can affect the heart, joints, brain and subcutaneous tissues (the innermost layer of skin). While there is no lasting damage caused to the brain, joints and skin, ARF may cause lasting damage to the heart.
Rheumatic heart disease (RHD) is caused by damage to heart valves as a result of one or more 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 common in 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.
How many people have 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 individuals 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.
How many Indigenous Australians have acute rheumatic fever?
In 2013–2017, there were 1,776 diagnoses of ARF among Indigenous Australians, a rate of 85 per 100,000 population. A higher rate of ARF diagnoses was recorded for Indigenous females (1,006 diagnoses, 96 per 100,000 population) than males (770 diagnoses, 74 per 100,000 population) and for the age group 5 to 14 (602 diagnoses, 195 per 100,000 population).
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.
How many people have rheumatic heart disease?
As at 31 December 2017, there were 4,255 people living with RHD recorded on state and territory registers, of whom 87% were Indigenous Australians (3,687 diagnoses). NT has the greatest number of people living with RHD. The most common age group at diagnosis was 15–24 years, with 941 diagnoses (22%). Two-thirds of people living with RHD (65%, 2,783 diagnoses) were females.
How many Indigenous Australians have rheumatic heart disease?
In 2013–2017, there were 1,043 RHD new diagnoses of RHD 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 diagnoses were made in people aged under 25 years.
How many Indigenous Australians are prescribed 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 Australians prescribed BPG:
- 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.