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Sore Throats Can Break A Heart: Rheumatic Fever In The Bay Of Plenty

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Fuseworks Media
Fuseworks Media

The chances of New Zealand European children getting rheumatic fever are one in 10,000, but the Public Health Association conference was told today that in some Maori communities in the Bay of Plenty, the chances are as high as one in 39.

These staggering statistics are from Dr Belinda Loring's work for Toi te Ora Public Health in the Bay of Plenty, and have triggered several community prevention projects.

"Rheumatic fever is a disease where Maori and Pacific children are highly overrepresented, where overcrowding and access to timely and appropriate health care can be an issue." says Dr John Malcolm, a Bay of Plenty District Health Board paediatrician.

New Zealand's Rheumatic fever rate for Maori and Pacific is now one of the highest in the world. Throughout the 1990s, there were more than 120 deaths per year from heart disease caused by rheumatic fever. Of the communicable diseases in New Zealand, only AIDS causes greater premature death for those aged less than 65 years.

Dr Malcolm says the need to take sore throats more seriously has led to the development of the slogan 'Sore throats matter' which is now commonly seen, or heard around the Bay.

"Sore throats are a sign of the Group A Streptococcus bacteria that causes rheumatic fever and then damages the heart, but the bacteria often flies under the radar. Particularly in low income families, there are often so many other things to worry about, that a sore throat can seem minor.

He says doctors need a paradigm shift to recognise the susceptibility in some populations, to recognise the importance of checking their throat swabs, prescribing penicillin and following up cases. "Children who go onto two or three bouts of rheumatic fever can suffer heart failure, a stroke or infected valves in their 20s, 30s and beyond, so clinical follow-up and penicillin protection are essential."

The programmes use echocardiography and heart ultrasound techniques to find previously undetected damage in children who have been infected.

"So far, for every child known to have had Rheumatic fever we have found another with rheumatic heart disease. Those children will be followed up over the years with monthly doses of penicillin to prevent the Group A strep bacteria taking hold again," Dr Malcolm said.

"Our communities are increasingly aware that sore throats matter; rheumatic fever can break a heart and penicillin can, for some, help mend it."

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