Rheumatic fever rate 'a disgrace'

BY KATE NEWTON

New Zealand's extraordinary rates of rheumatic fever are a disgrace and it is an embarrassment the disease even exists here, GPs and paediatricians say.

About 600 children in Northland have undergone screening in the past week for heart damage caused by rheumatic fever, which is caused by streptococcus throat infections and can lead to serious cardiac problems and even death.

Although research has focused on children in South Auckland and Northland, even New Zealand's overall rates are 14 times the OECD average and paediatricians say the disease needs urgent Government attention.

Parts of Wellington have abysmal rates of rheumatic fever – including Porirua East, which carries the dubious honour of having the country's highest incidence of the disease.

Doctors in the region are calling for sore throat clinics in schools and heart screening for local children who may have slipped through the cracks.

Nationally, rates of rheumatic fever are six in 100,000, rocketing to 106 in 100,000 in Porirua East.

Regional Public Health medical officer of health Margot McLean said New Zealand's rates were "a national disgrace".

"I think we should be concerned. [It's] a disease which is almost unheard of in countries in Europe, for instance. Why New Zealand has still got these high rates is hard to explain, except that New Zealand has a higher rate of children living in poverty."

Wellington paediatric surgeon Brendon Bowkett said the rates were "bloody frightening".

"The Government has a responsibility to deal with this epidemic. There really needs to be a government directive."

Wellington Hospital paediatrician Alan Farrell said it was not well understood why rheumatic fever developed in some children and not others but the disease was associated with overcrowding and low income.

"I think rheumatic fever is an indicator of how we're treating the people at the bottom of the heap."

Six to eight Wellington children developed acute rheumatic fever each year, some of whom needed urgent open-heart surgery to replace badly damaged valves.

"To have a new valve put in when you're 10 or 12 is a pretty big deal and it means you're going to have ongoing issues the rest of your life."

Children diagnosed with even mild rheumatic fever had to endure painful monthly penicillin injections for 10 to 15 years, to prevent further attacks that could cause rheumatic heart disease.

Dr Farrell supported heart screening for all at-risk children to ensure cardiac problems caused by rheumatic fever did not go undetected.

"If you can identify them early in life when the heart valve damage is minor, then you can protect them."

His colleague, paediatrician Nikki Blair, also wanted heart screening introduced in Wellington.

She advocated sore throat clinics in low-decile schools to catch "strep throat" before it developed into full-blown rheumatic fever.

Porirua Union Health GP Bryan Betty said he and his colleagues were "well aware of the problem" and the high rates were an embarrassment.

"It's not unusual for patients in an area like ours to be on penicillin injections."

It could be hard convincing people it was worth taking their child to see a doctor when they had a sore throat, and how important it was to complete a full course of antibiotics.

Capital & Coast District Health Board has convened a group to try to lower local rates and the Health Ministry said rheumatic fever was "a priority work area".

That included employing a rheumatic fever sector leader to work with health boards with high rates, better monitoring, collaborating with other agencies to improve housing conditions and ensuring doctors were aware how serious the disease was.

WHAT IS RHEUMATIC FEVER?

Rheumatic fever is an illness caused by a reaction to a streptococcus A throat infection.

About 70 per cent of children who get rheumatic fever will have some heart damage, which can lead to rheumatic heart disease.

About 145 people die from rheumatic heart disease each year, many of them in their 40s and 50s or sometimes even younger.

Almost all instances of the disease are preventable, with proper treatment of a sore throat reducing the risk by about 80 per cent.

Children with rheumatic fever are treated with monthly penicillin shots until they reach their early 20s, saving them from heart-valve replacements or transplants.

- © Fairfax NZ News