11th August 2017, Volume 130 Number 1460

Diana Lennon, Te Aro Moxon, Philippa Anderson, Alison Leversha, Timothy Jelleyman, Peter Reed, Catherine Jackson

Rheumatic heart disease (RHD), the long-term sequela of acute rheumatic fever (ARF), can persist for life.1 Despite ARF being preventable, the associated morbidity and mortality continue to be a significant…

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Summary

Rheumatic fever is preventable. It causes long-term heart disease in many and can even cause premature death. It is important to count the cases carefully and accurately as there is an important campaign underway to prevent it by treating strep sore throats. We looked at the different methods for case counting. A register is the best way, well established in the Auckland region for several decades and leading to the current MOH campaign.

Abstract

Aim

To determine the most accurate data source for acute rheumatic fever (ARF) epidemiology in the Auckland region.

Method

To assess coverage of the Auckland Regional Rheumatic Fever Register (ARRFR), (1998–2010) for children <15 years and resident in Auckland at the time of illness, register, hospitalisation and notification data were compared. A consistent definition was applied to determine definite and probable cases of ARF using clinical records. (www.heartfoundation.org.nz)

Results

Of 559 confirmed (definite and probable) RF cases <15 years (median age 10 years), seven were recurrences. Of 552 first episodes, the ARRFR identified 548 (99%), hospitalisations identified 501 (91%) including four not on the register, and public health notifications identified 384 (70%). Of hospitalisation cases, 33% (245/746), and of notifications 20% (94/478) did not meet the case definition and were therefore excluded. Between 1998–2010, eight cases, initially entered as ARF on the ARRFR, were later removed once further clinical detail was available.

Conclusion

The ARRFR produced the most accurate information surrounding new cases of ARF (for children <15 years) for the years 1998–2010 in Auckland. This was significantly more accurate than medical officer of health notification and hospitalisation data.

Author Information

Te Aro Moxon, Clinical Research Fellow, Department of Paediatrics, University of Auckland, Auckland; Peter Reed, Bio-Statistician, Starship Children’s Hospital, Auckland DHB, Auckland;
Timothy Jelleyman, Paediatrician, Waitākere Hospital, Waitematā District Health Board, Auckland; Philippa Anderson, Public Health Physician, Population Health Team, CMDHB, Auckland;
Alison Leversha, Honorary Academic, Department of Paediatrics, University of Auckland, Auckland; Catherine Jackson, Public Health Medicine Specialist, Auckland DHB, Auckland.

Acknowledgements

The vision of RF control in New Zealand began in Rotorua and Tairāwhiti in the 1960’s and 1970’s. The National RF Working Party was an important step forward. Partnership with Māoridom has been evident from the beginning.

Correspondence

Diana Lennon, Professor of Population Child & Youth Health, Paediatrician in Infectious Diseases, Kidz First and Starship Children’s Hospitals, Community Paediatrics Department of Paediatrics: Child & Youth Health, The University of Auckland, School of Population Health, Private Bag 92019, Auckland 1142.

Correspondence Email

d.lennon@auckland.ac.nz

Competing Interests

Dr Jackson reports personal fees from HDEC Northern A Ethics Committee (Dec 2016–present) outside the submitted work.

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