Rheumatic fever and chronic rheumatic heart disease in Yarrabah Aboriginal community, north Queensland: Establishment of a prophylactic program

139

107

There is a lack of good quality prevalence surveys of rheumatic heart disease in developing countries. It appears that a threshold level where higher socio-economic status is associated with reduced prevalence of rheumatic heart disease is not reached in developing countries. Therefore, differences in prevalence between socio-economic groups in the one area cannot be detected. A similar case can be made for overcrowding. Many regions need well-designed studies of rheumatic heart disease that incorporate assessment of environmental factors as well as the study of the microbiological epidemiology of rheumatic heart disease and group A streptococci.

Section: Resultsmentioning

confidence: 99%

Systematic review of rheumatic heart disease prevalence in children in developing countries: The role of environmental factors

Steer

Carapetis

Nolan

et al. 2002

139

107

“…30 In the remote Australian Aboriginal population, the incidence of streptococcal sore throat is particularly low, suggesting that systematic sore throat treatment programmes would be unlikely to have any substantial impact. 13,[30][31][32] Given the absence of alternative approaches (a rheumatic fever vaccine remains at least a decade away, and skin sore control programmes are unproven to reduce rheumatic fever incidence), there is currently no proven strategy for primary prevention at the population level, although antibiotic treatment of streptococcal pharyngitis remains an important clinical strategy in primary care. Primordial prevention -improved housing, sanitation, medical care, etc.…”

Section: Preventionmentioning

confidence: 99%

“…However, attempts to systematically introduce primary prophylaxis through school or community‐based sore throat swabbing and treatment programmes have not resulted in proven or cost‐effective reductions in rheumatic fever incidence 30 . In the remote Australian Aboriginal population, the incidence of streptococcal sore throat is particularly low, suggesting that systematic sore throat treatment programmes would be unlikely to have any substantial impact 13,30–32 . Given the absence of alternative approaches (a rheumatic fever vaccine remains at least a decade away, and skin sore control programmes are unproven to reduce rheumatic fever incidence), there is currently no proven strategy for primary prevention at the population level, although antibiotic treatment of streptococcal pharyngitis remains an important clinical strategy in primary care.…”

Section: Preventionmentioning

confidence: 99%

Rheumatic fever in Indigenous Australian children

Parnaby

Carapetis

2010

121

Rheumatic heart disease (RHD) caused by acute rheumatic fever (ARF) is a disease of poverty, poor hygiene and poor living standards. RHD remains one of the major causes of childhood cardiac disease in developing nations. Within developed nations, there has been a dramatic drop in the prevalence of RHD because of the improvement of living standards, access to health care and the widespread availability of penicillin-based drugs. Despite a dramatic reduction of RHD in Australia overall, it continues to be a major contributor to childhood and adult cardiac disease in Indigenous communities throughout northern and central Australia. Currently, Australia has among the highest recorded rates of ARF and RHD in the world. The most accurate epidemiological data in Australia come from the Northern Territory's RHD control programme. In the Northern Territory, 92% of people with RHD are Indigenous, of whom 85% live in remote communities and towns. The incidence of ARF is highest in 5-14-year-olds, ranging from 150 to 380 per 100,000. Prevalence rates of RHD since 2000 have steadily increased to almost 2% of the Indigenous population in the Northern Territory, 3.2% in those aged 35-44 years. Living in remote communities is a contributing factor to ARF/RHD as well as a major barrier for adequate follow-up and care. Impediments to ARF/RHD control include the paucity of specialist services, rapid turnover of health staff, lack of knowledge of ARF/RHD by health staff, patients and communities, and the high mobility of the Indigenous population. Fortunately, the recently announced National Rheumatic Fever Strategy, comprising recurrent funding to the Northern Territory, Queensland and Western Australia for control programmes, as well as the creation of a National Coordination Unit suggest that RHD control in Australia is now a tangible prospect. For the disease to be eradicated, Australia will have to address the underpinning determinants of poverty, social and living conditions.

“…The point prevalence of established rheumatic heart disease amongst all ages in Aboriginal people was 11.8 per 1000, with a rate of 22.4 per 1000 in the 12 selected communities. Rheumatic fever and rheumatic heart disease are also common in Aboriginal communities in the Kimberley and north Queensland 18–;20 …”

Section: Infectious Diseases In Aboriginal Childrenmentioning

confidence: 99%

Childhood infections in the tropical north of Australia

Currie¹,

Brewster²

2001

In the tropical north of Australia there are high rates of infections in Aboriginal children living in remote communities. In addition to the burden of respiratory infections, diarrhoeal disease and skin sepsis, there are high rates of acute rheumatic fever, outbreaks of poststreptococcal glomerulonephritis and gonococcal conjunctivitis, endemic trachoma and various intestinal parasites. A number of infections generally restricted to the tropics are also present and can cause disease in both indigenous and non-indigenous children. These include melioidosis, Murray Valley encephalitis and dengue on the east coast. With global warming, these infections may become more common and more widespread within Australia and the potential for establishment of introduced infections such as Japanese encephalitis and malaria may increase.