The Epidemiology of Acute Rheumatic Fever In Northland, 2012–2017

Abstract

Aim: The audit was to establish accuracy and completeness of acute rheumatic fever (ARF) surveillance in Northland for the period 2012–2017 and compare rates of ARF with the previous audit. Methods: Cases of ARF were identified and evaluated through the national surveillance database (EpiSurv), the Northland Rheumatic Fever secondary prophylaxis register and hospital discharges. Cases were included if they were Northland residents and met ARF diagnostic criteria as per the 2014 New Zealand Heart Foundation guidelines. Results: A total of 69 ARF cases met audit criteria, an annualised incidence rate of 7.0/100,000. 93% of cases were Māori. The 5–14 year age group had the highest rates which also demonstrated the greatest disparity between Māori (64.5/100,000), Pacific (54.6/100,000) and Non-Māori/Non-Pacific (1.5/100,000). Ten new cases of ARF were diagnosed in patients aged 20 years or older. Of the 14 ‘medium-to-high-risk’ carditis cases, 6 were older than 15 years. ARF was strongly associated with level of deprivation, with 87% of cases in NZDep8-10. Conclusion: ARF rates among Northland Māori aged 5–14 years (64.5/100,000) remain similar to those in third-world countries. Adults (≥16 years old) showed disproportionate rates of ‘medium-to-high-risk’ carditis. A marginal improvement from the previous audit was seen for Māori despite the Rheumatic Fever Prevention Programme, a discrepancy compared with The Ministry of Health's recent publications which indicate a large improvement in ARF rates for Northland. This audit highlights the significant, ongoing need in Northland for good data collection so ARF prevention efforts can be resourced appropriately.