Health authorities and clinicians are working on a new rheumatic fever programme to improve treatment for what has been labelled a third-world disease in New Zealand.

New health authorities Te Whatu Ora Health NZ and
Te Aka Whai Ora Maori Health NZ are working with clinicians from around the country to set up a register that will streamline the documentation and treatment of rheumatic fever cases.

The inflammatory disease, which can develop when strep throat isn’t properly treated, is most common in the North Island, particularly in the Northland, Counties Manukau and Tairāwhiti district health board areas as well as in Waitematā, Auckland, Waikato and Lakes.

Hawke’s Bay, Hutt and Capital and Coast also record some cases. Further south, only Canterbury and Southern have had sporadic cases over the past decade.

Last year Northland recorded 12 new cases of rheumatic fever from 93 nationally.

The new register would give healthcare professionals better access to patients’ health records and provide improved guidance for patient-centred care.

“Existing registers do not support or facilitate shared care between two or more districts for people who move between areas,” Te Whatu Ora interim director of population health commissioning, Deborah Woodley, said.

The current registers varied in their functionality and integration. Districts use different IT platforms for their health data and do not allow the electronic transfer of patients.

“A single joined-up system will better support co-ordination of care between providers and reduce the risk of patients being lost in the system.

“It will create a single source of the information that is critical to providing the highest-quality care and follow-up.”

Follow-up treatment after the first break out of rheumatic fever is important to prevent serious damage, such as heart disease.

When a patient is diagnosed with rheumatic fever for the first time they usually receive hospital care. It is then considered a long-term medical condition and can break out again.

To prevent further episodes, patients receive a monthly antibiotic injection for at least 10 years.

“They are injections that stop the streptococcus from colonising the throat and triggering the rheumatic fever recurrence which can further damage the heart,” Whangārei general practitioner Dr Tim Cunningham explained.

“It is usually a long-acting penicillin – a painful injection. These poor patients have a really tough day every month when the district nurse comes to give the injections.”

He said sadly, compliance with oral medications is often poor, causing a lot of preventable breakthrough disease.

Eighty to 85 per cent of rheumatic fever cases in Northland had carditis (heart damage) when they were diagnosed for the first time, Te Whatu Ora Te Tai Tokerau told the Advocate as part of an OIA request.

In her 2020 election campaign, Prime Minister Jacinda Ardern pledged to eradicate New Zealand’s “national shame” and promised more funding, especially for Healthy Homes.

The Healthy Homes policy implemented by the then-National Government in 2013 is a set of minimum standards for heating, insulation, ventilation, moisture and drainage, and draught-stopping in rental properties.

Poor housing conditions lead to the spread of respiratory illnesses, including strep throat.

Ngāti Hine Health Trust CEO Geoff Milner said housing issues were prevalent in Northland, which explained the high number of rheumatic fever cases.

“Healthy Homes has delivered warm homes in the region. I’m a great advocate for the initiative. That being said, it is one thing to have warm homes, another to have homes.”

Milner said a high number of Northlanders were living in cars, tents, crowded houses and mould-infested accommodation.

“If people are worried about paying their bills and how to feed their children a sore throat becomes secondary. That is just the reality.”

Additionally, many in Northland couldn’t even enrol with GPs because their books are closed, Milner said.

A re-emphasis on why sore throats matter was important for the region to reduce rheumatic fever numbers.

What is rheumatic fever?
Rheumatic fever starts with a sore throat, which is known as strep throat. It is a contagious infection caused by a bacteria called Streptococcus. It is different from a viral sore throat you might get with a cold. If strep throat lingers and is not treated with antibiotics it can cause rheumatic fever in children and young people. Rheumatic fever is an autoimmune disease. It happens when your child’s immune system attacks healthy parts of the body as well as the strep throat germs. The heart, joints (elbows and knees), brain and skin become inflamed and swollen. The inflammation from even one rheumatic fever attack can develop into rheumatic heart disease where there is scarring of the heart valves.

How do I recognise strep throat?
Symptoms of strep throat can include: a painful or scratchy throat, especially when you swallow; redness at the back of the mouth; fever; bad breath; swollen glands in the neck and swollen tonsils covered in white stuff. It’s very difficult to tell the difference between a viral sore throat and a strep throat. Every time your child has a sore throat, it is advised to get them checked by a health professional. Children and young, Māori and Pasifika, and those living in poorer or crowded living conditions are more at risk.

What treatment is available?
Strep throat is usually treated with oral antibiotics for 10 days or a one-off penicillin injection which clears the infection and prevents rheumatic fever. When a patient is diagnosed with rheumatic fever for the first time they are usually admitted to hospital. To prevent further outbreaks, patients will receive regular antibiotic injections for at least 10 years.