• 1.

    Carapetis JR 2016. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2: 15084.

  • 2.

    Coffey PM, Ralph AP, Krause VL, 2018. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: a systematic review. PLoS Negl Trop Dis 12: e0006577.

    • Search Google Scholar
    • Export Citation
  • 3.

    Australian Health Ministers’ Advisory Council, 2017. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report. Canberra, Australia: Australian Health Ministers’ Advisory Council.

    • Search Google Scholar
    • Export Citation
  • 4.

    Ralph AP, Noonan S, Wade V, Currie BJ, 2020. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. Med J Aust 2020 Nov 15. doi: 0.5694/mja2.50851.

    • Search Google Scholar
    • Export Citation
  • 5.

    Torres Strait Islander Regional Council, 2016. Culture, Protocols and Heritage. Available at: www.tsirc.qld.gov.au/our-communities/culture-protocols-heritage. Accessed June 1, 2020.

    • Search Google Scholar
    • Export Citation
  • 6.

    Remenyi B 2012. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nat Rev Cardiol 9: 297309.

    • Search Google Scholar
    • Export Citation
  • 7.

    Carapetis J 2012. The Australian Guideline for Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease, 2nd edition. Darwin, Australia: RHD Australia. Available at: https://researchers.cdu.edu.au/en/publications/the-australian-guideline-for-prevention-diagnosis-and-management.

    • Search Google Scholar
    • Export Citation
  • 8.

    Australian Bureau of Statistics, 2016. 2016 Census. Available at: https://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/POA4875. Accessed November 11, 2020.

    • Search Google Scholar
    • Export Citation
  • 9.

    Davis K 2018. Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study. Med J Aust 208: 303307.

    • Search Google Scholar
    • Export Citation
  • 10.

    White H, Walsh W, Brown A, Riddell T, Tonkin A, Jeremy R, Brieger D, Zeitz C, Kritharides L, 2010. Rheumatic heart disease in indigenous populations. Heart Lung Circ 19: 273281.

    • Search Google Scholar
    • Export Citation
  • 11.

    Francis JR 2020. Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening. Med J Aust 213: 118123.

    • Search Google Scholar
    • Export Citation
  • 12.

    , 2007. Why are medical practitioners in north Queensland missing cases of acute rheumatic fever? Trop Popul Health Unit Netw Commun Dis Control Newsl 55: 14.

    • Search Google Scholar
    • Export Citation
  • 13.

    Wu J, Taylor D, Ovchinikova L, Heaney A, Morgan T, Dartnell J, Holbrook R, Humphreys L, Weekes L, Blogg S, 2018. Relationship between antimicrobial-resistance programs and antibiotic dispensing for upper respiratory tract infection: an analysis of Australian data between 2004 and 2015. J Int Med Res 46: 13261338.

    • Search Google Scholar
    • Export Citation
  • 14.

    Tarca AJ, Hand RM, Wyber R, 2019. Call for a national sore throat guideline. Med J Aust 210: 477477.e1.

  • 15.

    Parks T, Smeesters PR, Steer AC, 2012. Streptococcal skin infection and rheumatic heart disease. Curr Opin Infect Dis 25: 145153.

  • 16.

    McDonald MI, Towers RJ, Andrews RM, Benger N, Currie BJ, Carapetis JR, 2006. Low rates of streptococcal pharyngitis and high rates of pyoderma in Australian aboriginal communities where acute rheumatic fever is hyperendemic. Clin Infect Dis 43: 683689.

    • Search Google Scholar
    • Export Citation
  • 17.

    Guthridge I, Smith S, Horne P, Hanson J, 2019. Increasing prevalence of methicillin-resistant Staphylococcus aureus in remote Australian communities: implications for patients and clinicians. Pathology 51: 428431.

    • Search Google Scholar
    • Export Citation
  • 18.

    Nofz L, Koppen J, De Alwis N, Smith S, Hanson J, 2019. The microbiology of ear cultures in a high-burden setting in tropical Australia: implications for clinicians. Clin Otolaryngol 44: 11951200.

    • Search Google Scholar
    • Export Citation
  • 19.

    Smith S, Russell D, Horne P, Hanson J, 2019. HTLV-1 is rare in Far North Queensland despite a significant burden of classically associated diseases. Pathology 51: 9194.

    • Search Google Scholar
    • Export Citation
  • 20.

    Australian Bureau of Statistics, 2018. Labour Force, Australia. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/lookup/6202.0Media%20Release1Jun%202018. Accessed November 24, 2020.

    • Search Google Scholar
    • Export Citation
  • 21.

    Australian Bureau of Statistics, 2016. Census of Population and Housing: Socio-Economic Indexes for Areas, Australia. Available at: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001∼2016∼Main%20Features∼What%20is%20SEIFA%3f∼8. Accessed June 1, 2020.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kang K, Chau K, Howell E, Anderson E, Smith S, Davis T, Starmer G, Hanson J, 2020. The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997–2017; impact of socioeconomic status on disease burden, severity, and access to care. PLoS Negl Trop Dis, In press.

    • Search Google Scholar
    • Export Citation

 

 

 

 

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

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  • 1 Torres and Cape Hospital and Health Service, Thursday Island, Australia;
  • 2 James Cook University, Cairns, Australia;
  • 3 Cairns Hospital and Hinterland Health Service, Cairns, Australia;
  • 4 The Kirby Institute, Sydney, Australia

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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