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FactsDid you know...

Rheumatic fever is a serious disease that can lead to permanent heart damage

It is almost three times more common in the Bay of Plenty than in New Zealand overall

Maori and Pacifi c children aged between 5 -14 years are most at risk of developing rheumatic fever

Rheumatic fever is preventable provided sore throats are treated correctly

An untreated sore throat (‘strep throat’) can cause rheumatic fever

If a child complains of a sore throat make sure they are checked by a doctor

If a ‘strep throat’ is diagnosed, the doctor will usually prescribe a 10 day course of antibiotics

It is important to complete the whole 10 day course to prevent rheumatic fever from developing

Sore throats matter – get them checked!

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A healthy throat, a healthy heart.He korokoro ora he manawa ora mo tatou katoa(A healthy throat, a healthy heart for all of us)

Whakatane paediatrician Dr John Malcolm shares his perspective on rheumatic fever, rheumatic heart disease and the healthy throats and hearts projects in the Bay of Plenty.

Healthy throats and hearts projects based inTaneatua, Murupara & KawerauIn late 2009, the opportunity arose for two echocardiograph heart studies to check for undiagnosed rheumatic heart disease amongst 10-12 year old children living in high incidence areas in the Eastern Bay of Plenty. After months of consultation and planning the echo studies were conducted in April and May 2010, led by Starship Heart Specialist Dr Nigel Wilson, Hana Harawira’s Early Intervention team with Taneatua based Te Kaokao o Takapau, Lyn Hartley’s team for Kawerau PHO and myself.

Support for the studies came from Kawerau PHO, Tuwharetoa ki Kawerau, Te Ao Hou PHO, Te Kaokao of Takapau, Toi Te Ora - Public Health and BOPDHB and Norske Skog. Northern Regional ethics committee granted approval with appropriate community support. School principals were involved discussing the project and staff assisted distributing fl yers and consents to pupils. Local radio stations and media have been highlighting the ‘sore throats matter’ message.

The fi rst study commenced on the 26

April at Te Kura Kaupapa Maori o Tawhiuau and then moved to Taneatua school where local schools sent their pupils. Over the week 290 children had an echo check. Kawerau’s echo week began on 17 May where 250 children were checked. Two echocardiographers came from Auckland & Gisborne each week. Dr Nigel Wilson attended and thanked each team and had his research fellow Dr Bo Remenyi present each week to support the echocardiography and assist with diagnosis. It will be some time until the full results of the project

are known because each abnormal echo is being peer reviewed by three consultants.

The goal of a national rheumatic fever workshop in Auckland in June 2009 was to outline strategy and process to ensure the reduction or acute rheumatic fever rates in Maori and Pacifi c young people (5-14 years) to European levels by 2020. The overarching conculsion of the workshop and published evidence supports that this is achievable. The Bay of Plenty and Lakes rheumatic fever steering group are currently working towards that goal.

Acute sore throat swabbing in schools for group A streptococcal infection (GAS) starts soon in Kawerau (and possibly Murupara in 2011) alongside community, nursing, Hauora & GP awareness raising. Those with known RHD have regular 28 day penicillin, with a Bay of Plenty and Lakes DHB wide register on the horizon to support timely care, as steps towards those achievable goals.

John Malcolm, Paediatrician

Rheumatic fever ‘licks the joints and bites the heart’. It follows a group A streptococcal throat infection (‘strep throat’). A few weeks later the following symptoms may develop: sore or swollen joints, shortness of breath, a skin rash, fever, jerky movements and fatigue. Although these symptoms may disappear,

the heart valves may be permanently damaged – this is called rheumatic heart disease (RHD)

Rheumatic heart disease kills an average of 145 New Zealanders each year. Both rheumatic fever and rheumatic heart disease are dear to the hearts of those looking at prevention, early detection and

good treatment, sharing the common goal of preventing loss of young and adults in their most productive years. Rheumatic heart disease survivors include Crusaders Robbie Fruen. Local heroes have fronted rheumatic fever campaigns in Opotiki, Taneatua and Kawerau.

Like the palisades of Maori pa or trenches of historic wars there are many lines of defence against rheumatic

fever, evolving with time and technology. One example of this is ultrasound, which was developed for submarine detection in World War 2. Using similar technology, echocardiographs (or ‘echos’) are able to scan the heart in detail and observe contractility (how effectively the heart is pumping), valve shape and valve leaks. Echocardiographs are a useful tool for doctors, children with rheumatic fever and their whanau. The echo machines are now portable, the size of a laptop and have come down in cost. The article below describes two healthy heart echocardiograph studies recently conducted in the Eastern Bay of Plenty. The aim of the studies was to check whether local childrens’ hearts were healthy at intermediate age, or whether they had undiagnosed rheumatic heart disease and congenital fi ndings as had been found in Auckland and East Coast children in recent years.

Starship hospital cardiologist Nigel Wilson with an echocardiogram that measures heart performance. Photo: Paul Estcourt

Echocardiogram heart image.