THE NEW Zealand Government's allocation of $21 million in the 2013 Budget for treatment and prevention of acute rheumatic fever (ARF) highlights the impact this disease has on the long-term health of New Zealand's marginalised communities. ARF is a disease confined largely to developing nations and is regarded in the developed world as a disease of deprivation and poverty, yet New Zealand has a high incidence, largely within Maori and Pacific populations.
ARF arises from an often mild throat infection caused by streptococcal bacteria. The mechanisms by which this microorganism triggers rheumatic fever and its cardiac sequelae are complex. Awareness of these mechanisms can help health professionals understand prevention and treatment strategies designed to reduce the burden of ARF in vulnerable communities.
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Introduction
Acute rheumatic fever (ARF) arises from what may start as a mild throat infection, but the announcement by the New Zealand Government in its 2013 budget that it would allocate $20 million for treating and preventing the disease shows the impact it is having in poorer communities in this country. The new funding for tackling ARF adds to a $24 million investment by the Government in the rheumatic fever prevention programme, designed to reduce the incidence of ARF in New Zealand by two-thirds by 2017. (1)
Currently, the incidence of initial episodes of ARF is 4.2 cases per 100,000 population per year (equating to 187 new cases in 2011), 70 per cent of which occur in children aged five to 14 years. (1) However, recently published data shows that in Northland between 2002 and 2011, the annual incidence of ARF was 7.7 cases per 100,000. (2) When incidence was determined by ethnicity, the data shows that for Maori, the figures are 24.8 new cases per 100,000, compared to 0.6 per 100,000 for non-Maori. (2) Hospital discharge data shows an even higher incidence for Pacific populations--up to 37 times the rate for other ethnicities^ The incidence of ARF in other countries is highly variable: in North America and Europe, ARF was all but eliminated through improvements in living standards and health care in the mid 20th century; in sub-Saharan Africa, India and the Pacific, and poor communities in South Africa and South America, it remains a significant health burden. In Australia, Aboriginal and immigrant Maori and Pacific groups remain vulnerable--annual incidence in Aboriginal populations in the north of Australia is 250 to 350 per 100,000. (3) The World Heart Federation says rheumatic heart disease (RHD) is, globally, the most common cause of cardiovascular disease in the under-25 age group, with up to half a million deaths annually. (4)