New approaches to combating rheumatic fever in children

Rheumatic fever is one of the most serious childhood health issues in New Zealand causing chronic heart disease and fatalities later in life.

Speakers at the Public Health Summer School symposium are reporting on a range of approaches to combat this disease, including the urgent need to improve housing, swabbing and treating strep throat infections, use of probiotics, echocardiography to identify children with undiagnosed rheumatic heart disease, as well as prospects for a vaccine in the future.

"Thirty million people around the world have rheumatic heart disease, and more than 300,000 die from it each year, mainly in developing countries. In New Zealand and Australia, the problem is largely restricted to Māori, Pacific and Aboriginal people," says keynote speaker Professor Jonathan Carapetis from the Telethon Institute of Child Health Research in Perth.

Rheumatic fever is concentrated in children aged 5-14 years.  In New Zealand, rates in Māori children are about 40 per 100,000 and in Pacific children around 80 per 100,000.  In Australia rates are as high as 182 per 100,000 in indigenous Australian communities. By contrast rates in the European population are about 1-2 per 100,000 across both countries.

"In many ways, new approaches in New Zealand and Australia are leading the way in global efforts to control rheumatic fever.  The eyes of the world are on us," says Professor Carapetis.

Rheumatic fever has been identified (along with raising immunisation coverage) as the single major health goal for the public sector in New Zealand (Source: State Services Commission website).

The meeting also congratulated the New Zealand Government on its determination to lower rates of this disease and the investment of significant resources in achieving this goal. The New Zealand Ministry of Health is implementing a $24 million five-year campaign focused on establishing school-based sore throat swabbing services in communities where rheumatic fever rates are high.

The symposium was organised by Professor Michael Baker from the University of Otago, Wellington as part of the annual Public Health Summer School. 

"There are still major gaps in our understanding of what causes rheumatic fever and why disease rates are so much higher in indigenous populations.  Poverty, household crowding, and poor access to primary healthcare services are likely to play a part in these ethnic differences, but there appear to be other unexplained factors contributing to disease risk," says Professor Baker.

"Research needs to be an essential part of our prevention programme so we can find out what works, and rigorously test promising new approaches. New Zealand and Australia are well-placed to develop and use novel methods to combat rheumatic fever".

Around 80 people are attending the symposium on the 'Science of rheumatic fever surveillance and control' on Monday 4 February, followed by a meeting on rheumatic fever research on 5 February.  Speakers at the symposium include scientists and doctors from the Universities of Otago and Auckland, several district heath boards, Ministry of Health, and the New Zealand Heart Foundation.

Provided by University of Otago