Rheumatic fever rates fail to fall in central Auckland, Waitemata

By Martin Johnston

Professor Diana Lennon says the primary school-based programme in South Auckland has reduced rheumatic fever by 60 per cent. Photo / Dean Purcell.
Professor Diana Lennon says the primary school-based programme in South Auckland has reduced rheumatic fever by 60 per cent. Photo / Dean Purcell.

The Government is reshuffling money to bolster its rheumatic fever prevention programme throughout much of greater Auckland after officials admitted targets are not being met.

In the year to June, the 31 new cases of the potentially fatal disease in the Waitemata and central Auckland health districts were at least double the target level.

The Green Party blamed the housing crisis in Auckland - increased risk of rheumatic fever rates is linked to overcrowded housing - an assertion supported by district health board officials.

"Most regions are seeing reductions in rheumatic fever," said co-leader Metiria Turei, "but not in Auckland, where we know there are large numbers of people living in overcrowded, cold, damp and mouldy homes, and in cars and garages."

Health Minister Jonathan Coleman said his ministry's officials would work more closely with Auckland district health boards, especially Waitemata and central Auckland, "which need to identify how they will bring their numbers down to help them achieve their rheumatic fever targets.

"We're also boosting the rheumatic fever awareness raising activities in the region. To help this work the Government has reprioritised $875,000 from the $65 million invested through Vote Health to help prevent rheumatic fever."

The Government target is to reduce the annual number of new cases of acute rheumatic since 2012 by two-thirds by next June - to a rate of 1.4 cases per 100,000 people.

Auckland DHB had 19 new cases in the year to June 30, when its target was seven. Waitemata had 12 - double its target of six.

DHBs have funded sore-throat clinics at many primary schools in higher-risk areas.

Children who report a sore throat have them swabbed to test for streptococcal A infection and, if positive, are given antibiotics. Rheumatic fever is a complication of untreated strep A infection. It can cause heart-valve failure.

Waitemata and Auckland DHB officials said in a report that the primary-school programme in their districts "have limited population coverage" and were therefore unlikely to have reduced disease rates.

"Counties Manukau DHB has sufficient population coverage, over 80 per cent, through the school programme to target the vast majority of the at-risk community."

"However, the programme [in Auckland and Waitemata DHBs] may have curbed an increase in disease. In fact, we would suggest that, given the increase in housing-related poverty over the last five years, static, rather than increasing, levels of disease is indeed a positive outcome that has been delivered through health-driven interventions."

The DHBs and the ministry were discussing the expanded healthy-housing initiative.

Auckland University paediatrician Professor Diana Lennon said the South Auckland school-based programme had led to a 60 per cent reduction since 2011 in rheumatic fever in children aged 5 to 12.

She said the different ways the sore-throat programme had been delivered in central Auckland and Waitemata might have reduced its impact.

The higher-risk areas for getting the disease were more concentrated in South Auckland than in central Auckland and Waitemata, where the use of drop-in clinics in primary care had been included.

"The ministry said we can't address all this through school clinics because the concentration is not the same everywhere. They wanted to put money into ordinary primary care."

- NZ Herald

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