1. Rheumatic Fever in the BOP & Lakes bigger Rheumatic Fever in the BOP & Lakes A bigger problem than we thought Dr Phil Shoemack Medical Officer of Health September 2010

2. Acute Rheumatic Fever (ARF)  caused by the body’s immune response to Group A Streptococcus (GAS) infection  latent period ≈ 3 weeks  ARF = Inflammation of heart, joints, brain, skin  mostly children 5-14 years  recurrent episodes up to age 45

3. Chronic Rheumatic Heart Disease (CRHD)  permanent damage to heart valves  usually from recurrent ARF  but can be from one attack  prevalence of CRHD peaks in 25-34 year olds  60% of ARF cases result in CRHD  significant morbidity and mortality

4. BOP/Lakes Audit Notifications of ARF by TLA &DHB 1999-2007 (all ages) AreaTotal no. of cases No. of Māori cases No. of non- Māori cases Opotiki12 0 Kawerau11101 Whakatane41383 Rotorua42366 Tauranga20164 Taupo770 Western Bay14113 Lakes DHB49436 BOPDHB988711

5. Age-specific (5-14 years) annualised ARF incidence/100,000 by TLA, DHB & CAU 2003-7 Bay of Plenty/Lakes Audit

6. Murupara

7. Put another way:  a child in Murupara has a 1 in 39 chance of developing ARF during childhood (between 5- 14yrs)  a child in Opotiki has a 1 in 70 chance of developing ARF during childhood  nationwide, a pakeha child has a 1 in 10,000 chance

8. What can we do?  influence determinants of health  primary prevention of ARF by detecting and treating sore throats  awareness raising; “sore throats matter”  CPD re treatment of sore throats  throat swabbing in some schools  improve secondary prophylaxis systems  establish a register for tracking cases  evaluate success of programmes

9. www.toiteorapublichealth.govt.nz/rheumatic_fever