Echocardiographic Screening Detects a Significant Burden of Rheumatic Heart Disease in Australian Torres Strait Islander Children and Missed Opportunities for its Prevention

Allison Hempenstall Torres and Cape Hospital and Health Service, Thursday Island, Australia;
James Cook University, Cairns, Australia;

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Erin Howell Cairns Hospital and Hinterland Health Service, Cairns, Australia;

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Katherine Kang Cairns Hospital and Hinterland Health Service, Cairns, Australia;

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Ken W. T. Chau Cairns Hospital and Hinterland Health Service, Cairns, Australia;

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Amylou Browne Torres and Cape Hospital and Health Service, Thursday Island, Australia;

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Ella Kris Torres and Cape Hospital and Health Service, Thursday Island, Australia;
James Cook University, Cairns, Australia;

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Hylda Wapau Torres and Cape Hospital and Health Service, Thursday Island, Australia;

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Pelista Pilot Torres and Cape Hospital and Health Service, Thursday Island, Australia;

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Simon Smith Cairns Hospital and Hinterland Health Service, Cairns, Australia;

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Benjamin Reeves Cairns Hospital and Hinterland Health Service, Cairns, Australia;

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Josh Hanson Cairns Hospital and Hinterland Health Service, Cairns, Australia;
The Kirby Institute, Sydney, Australia

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ABSTRACT

Rheumatic heart disease (RHD) is almost entirely preventable, but its incidence in indigenous Australians remains one of the highest in the world. A community-based echocardiogram screening program of 862 Torres Strait Islander children identified 25 (2.9%) new cases of RHD. Among these 25 children, 5/7 (71%) prior acute rheumatic fever presentations had not been recognized. There was a history of microbiologically confirmed group A Streptococcus infection in 17/25 (68%) children with RHD compared with 9/25 (36%) controls (odds ratio [OR] [95% CI]: 3.78 [1.17–12.19], P = 0.03). This was more likely to be a skin swab (16/25 [64%] cases versus 6/25 [24%] controls) than a throat swab (1/25 [4%] cases versus 3/25 [12%] controls) (OR [95% CI]: 5.33 [1.51–18.90] [P = 0.01]), supporting a role for skin infection in RHD pathogenesis. Household crowding and unemployment were common in the cohort, emphasizing the need for prioritizing strategies that address the social determinants of health.

Author Notes

Address correspondence to Josh Hanson, The Kirby Institute, University of New South Wales, Sydney, Kensington 2052, Australia. E-mail: jhanson@kirby.unsw.edu

Authors’ addresses: Allison Hempenstall, Amylou Browne, Ella Kris, Hylda Wapau, and Pelista Pilot, Torres and Cape Hospital and Health Service, Thursday Island, Australia, E-mails: allison.hempenstall@health.qld.gov.au, amylou.browne@health.qld.gov.au, ella.kris@tsirc.qld.gov.au, hylda.wapau@health.qld.gov.au, and pilotpel06@gmail.com. Erin Howell, Katherine Kang, Ken W. T. Chau, Simon Smith, and Benjamin Reeves, Cairns Hospital and Hinterland Health Service, Cairns, Australia, E-mails: erinhowell21@gmail.com, katherine.kang@health.qld.gov.au, ken.chau@health.qld.gov.au, simon.smith2@health.qld.gov.au, and benjamin.reeves@health.qld.gov.au. Josh Hanson, The Kirby Institute, University of New South Wales, Kensington, Sydney, Australia, E-mail: jhanson@kirby.unsw.edu.

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