Reply to Letter Regarding Article, “Acute Rheumatic Fever and Rheumatic Heart Disease: Incidence and Progression in the Northern Territory of Australia, 1997 to 2010”

Echocardiography screening to detect rheumatic heart disease

“…Acute rheumatic fever incidence was similar across in RHD and non-RHD groups. The annual incidence in this cohort is similar to figures reported in other regions [7,30]. In addition to high ARF incidence, a significant proportion of children with normal echocardiograms at school presented 2 years later with either definite RHD (0.9%) or borderline RHD (12.8%).…”

“…Children with no RHD at age 9-10 years are at risk of developing ARF later in adolescence. Age matters in terms of cumulative incidence of ARF and of the prevalence of RHD [7,25,29]. Acute rheumatic fever incidence was similar across in RHD and non-RHD groups.…”

“…Unlike other countries, comprehensive programmes to tackle the burden of disease have proven inefficient so far in the region [6][7][8]. The World Health Organization has recommended active surveillance in order to initiate secondary prophylaxis early and prevent complications of the disease [9].…”

The modern epidemiology of heart valve disease

“…Incidence of ARF has been difficult to establish globally, with estimates ranging from 10 cases per 100 000 to as high as 374 cases per 100 000 in Pacific and indigenous Australian and New Zealand communities 4. Indigenous Australians aged 5–14 years (the peak age group to develop ARF) have an incidence of 194 per 100 000 5. Similarly, in New Zealand the overall population age-standardised incidence of 17.2 per 100 000 for ARF requiring hospitalisation masks an almost 20-fold increased rate for Māori (40 per 100 000) and a 40-fold increased rate in Pacific people (81 per 100 000) compared with New Zealanders of non-Māori/Pacific origin (2.1 per 100 000) 6…”

Etiologic predictive value of a rapid immunoassay for the detection of group A Streptococcus antigen from throat swabs in patients presenting with a sore throat

“…5,8 This is due to a high percentage of residents in this region living in remote communities, often in varying degrees of poverty and crowding, and is consistent with findings in the Northern Territory, Australia. 9 Whilst there is increasing suspicion and some evidence that ARF may also be related to chronic skin sores (pyoderma), 5 patients having a sore throat remain the main focus.…”