Left to right: Te Manihera Huriwai, Zoey Hatu-Edmonds and Eruera Hatu-Edmonds Huriwai (13). Photo / Andrew Warner
For Eruera Hatu-Edmonds Huriwai, acute rheumatic fever led to four painful months in Starship Hospital and heart surgery.
It's an illness that has hurt twice as many Bay of Plenty whānau in the past six months than in previous years and the Covid-19 lockdown is considered a possible cause.
In the six months to June 30, there were eight cases of rheumatic fever in the Bay of Plenty District Health Board and three in the Lakes DHB.
In comparison, there were nine cases in the Bay of Plenty DHB and 3 in Lakes for the whole of 2019.
Although the case numbers remain in the single digits, the repercussions of each are huge, involving weeks in hospital, sometimes months and penicillin injections every 28 days for at least 10 years.
Rheumatic fever starts with a sore throat (a streptococcal bacterial infection) but symptoms such as sore or swollen joints, a skin rash, a fever, stomach pain and jerky movements normally develop a few weeks later.
Even if symptoms ease, the fever can permanently damage heart valves and lead to rheumatic heart disease and the need for heart surgery to repair or replace the valves.
Eruera's symptoms last year included a rash and sore joints but doctors originally thought he had an allergic reaction and growing pains.
A subsequent visit to Rotorua Hospital led to a rheumatic fever diagnosis and an immediate transfer to Starship Children's Health in Auckland.
"He didn't complain of a sore throat but he's the type of kid who won't say anything unless he's really in pain," Eruera's mother Zoey Hatu-Edmonds told the Rotorua Daily Post this week, reflecting on the year since.
"We had seen the ads on TV but we never thought it would hit us."
Zoey had to commute between Auckland and Rotorua to see her son for the next four months.
"My mum took the whole time off work to be with Eruera 24/7 because I was pregnant with our baby, heavily pregnant, and we had our other kids back here."
"When we first took him up we didn't show much emotion around him," she said.
"The first three or four days were quite tough because he was really in pain then."
Eruera doesn't remember much about his initial time in hospital.
"I was just sore."
Visits meant a lot to him while he was restricted to bed rest.
He saw his baby sister for the first time when he was in hospital, had lots of whānau come to see him and even had a special visit from sports star Sonny Bill Williams.
When he finally got home he felt "free" and having normality return has been "good" but it hasn't been a fast process.
Eruera has only just been able to start back playing in a basketball team in the past two months.
Zoey hoped other parents would "take sore throats seriously".
"Don't just say 'see how you feel tomorrow' ... get them checked."
Her partner Te Manihera Huriwai said it had "definitely opened our eyes, with our other kids too".
Toi Te Ora, the public health unit for the Lake DHB and Bay of Plenty DHB, helps to oversee school-based throat-swabbing programmes to detect and treat strep throat and prevent rheumatic fever.
Those most at risk of rheumatic fever are children aged 4 to 19, Māori and Pasifika, and people who are living in damp, overcrowded housing.
Toi Te Ora staff are trying to figure out why there have been more cases in the Bay of Plenty than usual so far this year.
Medical Officer of Health Dr Phil Shoemack said the Covid-19 lockdown was "potentially" linked.
"When the schools closed, obviously, we were not able to keep delivering the school-based throat swabbing ... and you can imagine that in some households there might have been more crowding for the weeks we were in level 4 and level 3 because people came home and stayed home and spent their time in a confined space."
He said the fact GPs were not able to see children as readily "could have had an impact".
"It's a frustrating illness; we are learning all the time," he said.
"It's a good example of how difficult it is being a GP because they [someone with rheumatic fever] might have a fever, they might have had sore joints ... It can be a difficult diagnosis."
Niki Stefanogiannis, the Ministry of Health's deputy director of public and population health, said Capital & Coast, Hutt Valley and Waikato DHBs had also reported increases in rheumatic fever cases so far this year.
"There were 24 cases of rheumatic fever notified in April 2020 compared with 15 for the same month in 2019 nationally."
A Lakes DHB spokeswoman said staff continued the rheumatic fever preventative programmes through the lockdown "as much as possible including promoting sore throat testing at our swabbing sites and mobile community services over Covid-19 alert levels".
The DHB also has a "significant preventative programme in place" including the Healthy Homes programme.
The Bay of Plenty DHB referred requests for comment to Toi Te Ora.
The Government allocated $5 million per year to 2022 across the 11 DHBs with the highest incidences of rheumatic fever to reduce the number of cases.