Rheumatic fever in our own backyard

A warning has been issued in Northland for parents to take sore throats seriously after notification of four cases of acute rheumatic fever in the region recently.
Although it has the highest rates of rheumatic fever in the country, Northland is not the only region grappling with the problem.
New Zealand's overall rates are 14 times the OECD (Organisation for Economic Co-operation and Development) average and paediatricians say the inflammatory disease needs urgent government attention.
It is typically associated with Third World countries but the high rate of cases - particularly among Maori and Pacific Island children - is seen by health professionals as a shameful indicator of child health in New Zealand.
An article published in the New Zealand Medical Association Journal earlier this year says rheumatic fever and the heart disease it causes reflects "gross and intolerable health inequalities". The article continues: "This is a shameful situation, embarrassing and intolerable in the sense of our designation as a developed country. Rheumatic fever deserves top most priority for eradication and should be regarded as a key indicator of child health and how we as a community value our children."
Northland District Health Board's medical officer of health Dr Clair Mills says rheumatic fever is closely associated with poverty and overcrowding and is a very sensitive marker of inequalities in child health.
"It is often thought of as a Third World disease, but the rates of rheumatic fever in Maori and [Pacific Island] kids in New Zealand are very high. In addition to treating sore throats, it is important to address other issues like poor housing, overcrowding and low incomes, with over a third of our kids living in poverty," she says.
The onset of acute rheumatic fever occurs if the throat infection group A streptococcal is left untreated.
Acute rheumatic fever can cause serious heart damage. "While only 1 to 3 per cent of untreated group A strep throat infections go on to cause acute rheumatic fever, it is better to err on the side of caution," says Dr Mills.
Rheumatic fever is a preventable disease, once the group A strep throat infection is confirmed through a throat swab, 10 days of an oral antibiotic has been shown to greatly reduce the chances of the fever.
The Northland DHB is working with iwi health providers to raise awareness under a campaign that "sore throats matter" and via two school-based rheumatic fever prevention projects.
Dr Mills advice is simple: "If your child has a sore throat see a doctor or nurse and if you are prescribed antibiotics, it is important to finish the full 10-day course."
PREVENTION
* Here are ways that we can all take to make it harder for the strep bugs to be passed from one to another.
* Good Hand Hygiene - wash and dry your hands for 20 seconds with soap and running water, especially after coughing, sneezing and before eating or preparing food.
* Cough and sneezing etiquette - cover your coughs and sneezes.
* Do not smoke around your children.

THE NUMBERS
* There were 16 notifications of acute rheumatic fever in Northland in 2010. The Northland rate in 2010 of 10.3 per 100,000 was nearly three times higher than the national rate of 3.9 per 100,000.
* Virtually all cases in Northland occur in Maori school-aged children.
* One in  100  children in Kaitaia (seven out of 636 screened children) had heart damage caused by previous undiagnosed rheumatic fever in a research project carried out last July. 
* The number of rheumatic fever cases in Northland is increasing.