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A National Prospective Surveillance Study of Acute Rheumatic Fever in Australian Children

Noonan, Sara BN*; Zurynski, Yvonne A. MAppSc, PhD†‡; Currie, Bart J FRACP, DTM&H*§¶; McDonald, Malcolm MB BS, PhD; Wheaton, Gavin MB BS**; Nissen, Michael BMedSc MB BS††; Curtis, Nigel MB BS, PhD‡‡; Isaacs, David MD; Richmond, Peter MB BS, MRCP§§; Ramsay, James M. MB BS, FRACP¶¶; Elliott, Elizabeth J. MB BS, MD; Carapetis, Jonathan R. MB BS, PhD

The Pediatric Infectious Disease Journal: January 2013 - Volume 32 - Issue 1 - p e26–e32
doi: 10.1097/INF.0b013e31826faeb3
Original Studies

Background: Acute rheumatic fever (ARF) is an important cause of heart disease in Indigenous people of northern and central Australia. However, little is known about ARF in children across all Australian population groups. This national prospective study was conducted to determine patterns of disease, and populations and regions at highest risk.

Methods: The Australian Paediatric Surveillance Unit surveillance model was used to collect data on children with ARF across Australia. Children up to 15 years of age were included if they had an ARF episode diagnosed between October 1, 2007 and December 31, 2010 that met the case definition.

Results: ARF was identified in 151 children: 131 Indigenous Australians, 10 non-Indigenous Australians, 8 Pacific Islanders and 1 African (1 unknown). Common presenting features were joint symptoms, fever and carditis. Sydenham chorea was reported in 19% of children. Aseptic monoarthritis was a major manifestation in 19% of high-risk children. Seven non-Indigenous Australian children presented with classic, highly specific features compared with 23% of high-risk children, suggesting that subtle presentations of ARF are being missed in non-Indigenous children. Recent sore throat was reported in 33% of cases, including 25% of remote Indigenous children. There were delays in presentation to care and referral to higher-level care across urban/rural and remote areas.

Conclusions: ARF may be more common than previously thought among low-risk children. These data should prompt an awareness of ARF diagnosis and management across all regions, including strategies for primary prevention. There should be renewed emphasis on treatment of sore throat in high-risk groups.

From the *Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory; Australian Paediatric Surveillance Unit, Children’s Hospital at Westmead; Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales; § Northern Territory Clinical School; Royal Darwin Hospital, Darwin, Northern Territory; James Cook University, Cairns, Queensland; **Women’s and Children’s Hospital, Adelaide, South Australia; ††Royal Children’s Hospital, Brisbane, Queensland; ‡‡Royal Children’s Hospital, Parkville, Victoria; §§Princess Margaret Hospital; and ¶¶University of Western Australia School of Paediatrics and Child Health, Perth, Western Australia, Australia.

Accepted for publication August 17, 2012.

This study was supported by Australian Paediatric Surveillance Unit, Heart Foundation Australia. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Sara Noonan, BN, Menzies School of Health Research, PO Box 41096 Casuarina, Northern Territory 0811, Australia. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.