Rheumatic Fever Rheumatic Heart Disease in New Zealand

Rheumatic Fever & Rheumatic Heart Disease in New Zealand Joel Burnett

New Zealand v Island nation of ~ 4. 5 million people v First settled by Polynesians, from which Maori culture emerged v Later a British colony v Known for spectacular landscapes Map credit: http: //www. worldatlas. com/webimage/countrys/oceania/lgcolor/nzcolor. htm

Auckland & The City Hospital v New Zealand’s largest city, with a population of ~ 1. 5 million v Cultural hub of the country v Auckland City Hospital (ACH) is New Zealand’s largest public hospital and clinical research facility v Major referral center and teaching hospital Photo credit: http: //careers. adhb. govt. nz/Job. Search/Community. Long Term. Conditions. Directorate/tabid/133/Default. aspx

http: //www. nzherald. co. nz/nz/news/article. cfm? c_id=1&objectid= 11743776

Topic of Interest: Rheumatic Fever & Heart Disease v Newspaper headlines addressing Rheumatic Fever in New Zealand caught my attention in the months prior to departure v Rates of Rheumatic Fever in New Zealand are among the highest in the developed world v Having undertaken an elective in Cardiology at Auckland City Hospital, I was interested in Rheumatic Fever and its most deadly sequela, Rheumatic Heart Disease

Rheumatic Fever v Acute Rheumatic Fever is caused by an autoimmune response to Group A Strep pharyngitis v Manifestations of disease include arthralgia, fever and other markers of acute inflammation, rash, subcutaneous nodules, chorea and, when involving the heart, new murmurs and heart failure v Diagnosis is made of clinical grounds with reference to the Jones criteria; treatment includes symptom management, antibiotics for GAS eradication and, if necessary, heart failure management

Rheumatic Heart Disease v Acute Rheumatic Fever can cause pancarditis; recurrent cases may lead to progressive chronic heart disease v Valvulitis is common and most frequently involves the mitral valve, though other valves may be involved v Treatment for mild cases is limited to secondary prophylaxis of Rheumatic Fever while severe cases may require valve surgery in addition to secondary prophylaxis

Rheumatic Fever in New Zealand v Despite near-eradication of Rheumatic Fever in developed countries, rates in New Zealand have remained stable at about 200 cases per year since 1980 (15 per 100, 000) v Between 1993 -2009, rates of Rheumatic Fever increased by 79% and 73% for Maori and Pacific children, whereas rates for non-Maori and non-Pacific children fell by 71% v Incidence corresponds with ethnicity and SES v 70% of school-aged cases of Rheumatic Fever occurred in the most deprived quintile

Rheumatic Heart Disease in New Zealand v A recent study 74% of the 225 women undergoing valve replacement surgery in an Auckland registry were Maori or Pacific Island women with Rheumatic Heart Disease v Between 1992 -1996 there were 127 deaths per year as a result of Rheumatic Heart Disease in New Zealand v In 2005 and 2006 there were 175 and 186 deaths, respectively, as a result of Rheumatic Heart Disease

Prevention Efforts v Primary prevention strategies include efforts to • improve access to timely sore throat treatment • reduce household overcrowding • raise public awareness v Secondary prevention includes • Community registries • Monthly IM penicillin Photo credit: http: //www. arphs. govt. nz/healthinformation/ communicable-disease/acute-rheumatic-fever-and-sore-throats

Photo credit: http: //www. hpa. org. nz/what-we-do/rheumatic-fever/2014 -winter-rheumaticfever-awareness-campaign/2014 -campaign-materials-and-resources

Summary v Rheumatic Fever is a rare complication of Group A Strep pharyngitis and can be prevented with prompt and appropriate treatment with antibiotics v Rheumatic heart disease, a deadly sequela of Rheumatic Fever, most frequently manifests as disease of the mitral valve v Unlike most industrial nations, rates of Rheumatic Fever in New Zealand have remained stable at about 200 cases per year since 1980 (15 per 100, 000) v Prevention strategies include efforts to reduce overcrowding, increase access to sore throat treatment, and raise awareness

Clinical Experience v Murmur auscultation on the cardiology wards was exciting and memorable v Many patients, including some with Rheumatic Heart Disease, awaited valve surgery on the wards and had interesting murmurs v Learning from master clinicians to distinguish murmurs from one another was a profound experience

Cultural Experience v New Zealand is known as a playground for outdoor sports and adventure v Completing the Tongariro Alpine Crossing, a 12 mile trek, was a cultural highlight v Tongariro National park is a World Heritage site

References Marijon, Eloi et al. “Rheumatic Heart Disease. ” The Lancet 379 (2012) 95364. Milne, Richard et al. “Incidence of acute rheumatic fever in New Zealand children and youth. ” Journal of Paediatrics and Child Health 48 (2012) 685691. Wilson, Nigel. “Rheumatic Heart Disease in Indigenous Populations – New Zealand Experience. ” Heart, Lung, and Circulation 19 (2010) 282 -288.