Record on rheumatic fever 'shameful'

Trent Boswell-Wakefield and Johan Schoonbee from the Hawke's Bay Magpies rugby team get involved in a rheumatic fever promotion. Photo / Glenn Taylor

A medical leader has hit out at New Zealand's "shameful and intolerable" rate of rheumatic fever, a Third World disease associated with child poverty and overcrowding.

Professor Norman Sharpe, medical director of the National Heart Foundation, has thrown his support behind draft proposals to the Children's Commissioner by a group of experts to reduce child poverty, which include a universal child benefit, expansion of social housing and a free-food programme in schools.

In today's New Zealand Medical Journal, Professor Sharpe laments the findings of a new study on rheumatic fever that it has "persistently defied control", and he says this is an indicator of "how we value our children".

"Comparison of the inequitable poverty rates between children and the elderly in New Zealand is also pertinent - our children do not have a universal 'Super Gold Card'.

"I feel ashamed, I feel it is intolerable - we have people coming here from overseas, young doctors from the UK and they can't believe we have rheumatic fever. It scarcely exists in the UK," Professor Sharpe told the Herald.

He cited earlier research that had shown a big increase in the two decades to 2008 in the rate of hospital admissions for serious infectious diseases, with disproportionate increases for Maori, Pacific Islanders and poor people.

This occurred while the income gap between rich and poor widened.

He praised the Government's sore-throat swabbing programme in schools, which he expected would control rheumatic fever, but it was a "bandaid" and the problem needed to be addressed "upstream" too, by dealing with poverty, overcrowding and poor quality housing.

Rugby player Robbie Fruean, a Crusaders back, is a victim of rheumatic fever, which led to him having heart surgery in 2008 and may be hindering his career: All Blacks coach Steve Hansen said recently that Fruean's heart condition would prevent him from playing in the national team.

The new study checked hospital admission and disease reporting data to estimate the acute rheumatic fever rate in the Gisborne-East Coast region, which has had the country's highest rate.

The study found an all-ages rate of 15 cases per 100,000 Maori, which was 13 times greater than the rate among Pakeha. For school-aged Maori children, the rate was 59 per 100,000.

The researchers comment in their paper: "Throat swabbing resources and sore throat education needs to be expanded to facilitate the prevention of acute rheumatic fever."

Their paper cites a recently published disease study in which 685 children at Gisborne-East Coast schools known to have high rates of rheumatic fever had their hearts scanned. This found previously undetected rheumatic heart disease in one student, probable disease in seven, and possible disease in 19.

Rheumatic fever

What is rheumatic fever?
A complication of an infection that can start with a sore throat and is caused by a type of streptococcal bacteria.

How is it spread?
The bacteria are spread by coughing, sneezing and sharing eating utensils. Close contact through living in an overcrowded house increases the risk of rheumatic fever.

How common is it?
Around 150 new cases are reported nationally each year. Among NZ European children the rate is one case per 100,000 a year. Young Maori and especially Pacific Islanders have the highest rates, at around 40 per 100,000, which is up to 100 times greater than the rates in other developed countries.

What are the effects of the disease?
It can cause joint pain and damage the heart valves, leading to heart failure and premature death.

What is the treatment?
A 10-day course of oral antibiotics for the strep throat. Years of monthly antibiotic injections for rheumatic fever. Surgery to replace damaged heart valves.

Is rheumatic fever preventable?
Most cases are preventable. The Government has funded a five-year, $24 million prevention programme based on clinics at schools in many poor areas with a high rate of rheumatic fever. Children with a sore throat go to a nurse for assessment and possibly a throat swab and antibiotics.