Acute rheumatic fever and rheumatic heart disease are rare in affluent societies yet high rates persist among Aboriginal and Torres Strait Islander populations, especially those living in rural or remote settings.
Estimates for rheumatic heart disease in Australian children range from less than one per 1000 population in low- risk children, to 33 per 1000 in parts of the Northern Territory. Maori and Pacific Islanders and immigrants from developing countries are also likely to be at elevated risk.
In the latest edition of Australian Prescriber, this important problem in remote indigenous Australian communities is discussed by Associate Professor Anna Ralph, senior clinical research fellow from Menzies School of Health Research, Charles Darwin University, and colleagues from RHDAustralia
Rheumatic fever occurs in response to an infection caused by Group A streptococci. This infection is more common in disadvantaged communities where there are overcrowded living conditions. Repeated infections lead to rheumatic heart disease, which has high death rates.
“Many healthcare providers working with at-risk populations, have little experience with acute rheumatic fever and rheumatic heart disease, and might not know of the many resources available to guide diagnosis and management,” says Associate Professor Ralph. “It is important that they and patients are aware of the current evidence for treatment and recent changes in guidelines.”
Rheumatic fever is notifiable to public health units in Australian states and territories which have rheumatic heart disease control programs such as Western Australia, Northern Territory, Queensland, South Australia and New South Wales. The control programs are a vital resource in managing the disease by providing education and support to clinicians and patients through online training, videos and diagnostic tools.
The recommended treatment to prevent recurrences and development of rheumatic heart disease is an injection of penicillin every 28 days.
“Children embarking on the daunting prospect of at least 10 years of penicillin injections require sensitive, culturally appropriate engagement with healthcare systems and use of strategies to minimise the pain of injections, “ says Associate Professor Ralph. Adherence resources including smartphone applications, calendars, reminder cards and incentive programs are offered at some clinics”.
To read the full article and others visit nps.org.au/australianprescriber.
Australian Prescriber is an independent peer-reviewed journal providing critical commentary on therapeutic topics for health professionals, particularly doctors in general practice. It is published every two months and distributed to health professionals free of charge, and is available online at nps.org.au/australianprescriber
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