Incidence of Acute Rheumatic Fever and Rheumatic Heart Disease among Ethnic Groups, New Zealand, 2000–2018

Bennett, Julie; Zhang, Jingyan; Leung, William; Jack, Susan; Oliver, Jane; Webb, Rachel; Wilson, Nigel; Sika-Paotonu, Dianne; Harwood, Matire; Baker, Michael G

doi:10.3201/eid2701.191791

Cited by 56 publications

(70 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pacific Peoples under the age of 20 years were seven times more likely to have GAS detected in a skin swab and 70 times more likely to be hospitalised for ARF than European/Other ethnicities. These stark inequities mirror previously published ARF rates, which reported that between 2000-2018 Pacific Peoples (5–14 years of age) had the highest national hospitalisation rates for ARF (80 cases per 100,000 population), with these ARF incidence rates continuing to increase each year [ 11 ]. In addition, GAS detection in skin swabs and ARF rates were highest for those living in the most socio-economically disadvantaged areas.…”

Section: Discussionsupporting

confidence: 83%

“…Rates of ARF and RHD within NZ are significantly higher than rates in other high-income countries, such as the USA and those in Europe [6] , [7] , [8] . ARF occurs almost exclusively within indigenous Māori and Pacific Peoples in NZ, highlighting a pattern of inequities across a range of health indicators for these populations; however, the gradient is far more marked than for any other health condition [8] , [9] , [10] , [11] . The reasons for this extreme disparity for ARF between populations in NZ remain unclear.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Descriptive analysis of group A Streptococcus in skin swabs and acute rheumatic fever, Auckland, New Zealand, 2010–2016

Thomas

Bennett

Jack

et al. 2021

The Lancet Regional Health - Western Pacific

Self Cite

View full text Add to dashboard Cite

Background Group A Streptococcus (GAS) can trigger an immune-mediated response resulting in acute rheumatic fever (ARF). Historically, ARF has been considered a consequence of preceding GAS pharyngitis, but increasing evidence suggests that GAS skin infections may be a driver. Data on the primary care burden of GAS skin infection are limited. This paper aims to describe and compare the prevalence and distribution of GAS detection in skin swabs and ARF rates in the Auckland population. Methods This cross-sectional study used all laboratory skin swab data from people who had a skin swab taken as a result of a consultation with a health professional in the Auckland region (2010–2016). Initial primary hospitalisations for ARF were identified and all data were linked using unique patient identifiers to patient's age, prioritised ethnicity, sex, and socio-economic status. Findings 377,410 skin swabs from 239,494 individuals were included. 12·8% of swabs were GAS positive, an annual incidence of 4·8 per 1,000 person-years. Māori and Pacific Peoples under 20 years of age had markedly higher GAS detection in skin swabs (RR 4·0; 95% CI 3·9–4·2: RR 6·8; 95% CI 6·6–7·0) and significantly higher ARF rates (RR 30·3; 95% CI 19·5–46·9: RR 69·7 95% CI 45·8–106·1) compared with European/Other ethnicities. Interpretation The observation that GAS detection was markedly higher in Māori and Pacific Peoples provides a potential explanation for the marked ethnic differences in ARF. These findings support a greater focus on addressing the burden of skin infection in NZ, including as ARF prevention. Funding The first author received a training stipend from the New Zealand College of Public Health Medicine (NZCPHM) during her Masters of Public Health.

show abstract

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Descriptive analysis of group A Streptococcus in skin swabs and acute rheumatic fever, Auckland, New Zealand, 2010–2016

Thomas

Bennett

Jack

et al. 2021

The Lancet Regional Health - Western Pacific

Self Cite

View full text Add to dashboard Cite

show abstract

“…ARF rates for indigenous Australian, New Zealand Māori, and Pacific Islander populations are among the highest in the world ( 12 , 13 ). In New Zealand, deaths from ARF are uncommon, but RHD causes ≈140 deaths and 600 hospitalizations annually; Māori and Pacific Islander persons are overrepresented ( 14 ).…”

mentioning

confidence: 99%

Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989–2015

Oliver¹,

Robertson²,

Zhang³

et al. 2021

Emerg. Infect. Dis.

Self Cite

View full text Add to dashboard Cite

“…Approximately 60% of ARF cases progress to chronic rheumatic heart disease (RHD), which can cause permanent heart valve damage (3), with an estimated 33 million people living with RHD globally (4). Although ARF rates declined over the twentieth century, the disease persists in low-income countries and amongst disadvantaged communities in some high-income countries, with Indigenous Maōri and Pacific children in New Zealand and Aboriginal children in Australia having some of the highest incidences in the world (5,6).…”

Section: Introductionmentioning

confidence: 99%

Mapping Autoantibodies in Children With Acute Rheumatic Fever

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundAcute rheumatic fever (ARF) is a serious sequela of Group A Streptococcus (GAS) infection associated with significant global mortality. Pathogenesis remains poorly understood, with the current prevailing hypothesis based on molecular mimicry and the notion that antibodies generated in response to GAS infection cross-react with cardiac proteins such as myosin. Contemporary investigations of the broader autoantibody response in ARF are needed to both inform pathogenesis models and identify new biomarkers for the disease.MethodsThis study has utilised a multi-platform approach to profile circulating autoantibodies in ARF. Sera from patients with ARF, matched healthy controls and patients with uncomplicated GAS pharyngitis were initially analysed for autoreactivity using high content protein arrays (Protoarray, 9000 autoantigens), and further explored using a second protein array platform (HuProt Array, 16,000 autoantigens) and 2-D gel electrophoresis of heart tissue combined with mass spectrometry. Selected autoantigens were orthogonally validated using conventional immunoassays with sera from an ARF case-control study (n=79 cases and n=89 matched healthy controls) and a related study of GAS pharyngitis (n=39) conducted in New Zealand.ResultsGlobal analysis of the protein array data showed an increase in total autoantigen reactivity in ARF patients compared with controls, as well as marked heterogeneity in the autoantibody profiles between ARF patients. Autoantigens previously implicated in ARF pathogenesis, such as myosin and collagens were detected, as were novel candidates. Disease pathway analysis revealed several autoantigens within pathways linked to arthritic and myocardial disease. Orthogonal validation of three novel autoantigens (PTPN2, DMD and ANXA6) showed significant elevation of serum antibodies in ARF (p < 0.05), and further highlighted heterogeneity with patients reactive to different combinations of the three antigens.ConclusionsThe broad yet heterogenous elevation of autoantibodies observed suggests epitope spreading, and an expansion of the autoantibody repertoire, likely plays a key role in ARF pathogenesis and disease progression. Multiple autoantigens may be needed as diagnostic biomarkers to capture this heterogeneity.

show abstract

Incidence of Acute Rheumatic Fever and Rheumatic Heart Disease among Ethnic Groups, New Zealand, 2000–2018

Abstract: These conditions disproportionately affect Māori and Pacific Islanders, particularly those living in high socioeconomic deprivation.

Cited by 56 publications

References 22 publications

Descriptive analysis of group A Streptococcus in skin swabs and acute rheumatic fever, Auckland, New Zealand, 2010–2016

Descriptive analysis of group A Streptococcus in skin swabs and acute rheumatic fever, Auckland, New Zealand, 2010–2016

Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989–2015

Mapping Autoantibodies in Children With Acute Rheumatic Fever

Contact Info

Product

Resources

About