RHEUMATIC FEVER
PREVENTION PROGRAMME:
SORE THROAT SWABBING
SERVICE IN SCHOOLS
He korokoro ora
He manawa ora
Mo tatou katoa
A healthy throat,
a healthy heart for us all
Karen Clarke
Public Health Nurse
2012
Topics Covered
 Overview
of Rheumatic Fever in New Zealand
 What is Rheumatic Fever ?
 What is strep throat ?
 Signs and Symptoms of Strep throat (GAS)
 Do all sore throats lead to Rheumatic Fever?
 Why do sore throats matter?
 How can Rheumatic Fever be prevented?
 What is the Rheumatic Fever prevention
programme?
Rheumatic Fever in New
Zealand: An Overview



Rheumatic Fever is still common in NZ, even though it has
virtually disappeared in other industrialised countries.
It mainly occurs in Maori and Pacific children, in lower
socioeconomic areas of the North Island.
Rheumatic Fever is closely related to poverty and crowded
housing
 “The cost for rheumatic fever for the individuals affected, their
families and communities and the health sector is very high…. It
casts a long shadow” (Sharpe, 2011, p12)
WHAT IS RHEUMATIC FEVER?

Rheumatic Fever is serious preventable disease that can cause
permanent heart damage.

It often starts with a sore throat (a streptoccocal infection)

A few weeks after a child may develop:
▪
sore or swollen joints (knees, elbows, ankles and wrists)
▪
a skin rash
▪
a fever
▪
stomach pain
▪
jerky movements
Heart damage can develop immediately, or within a few months.
“Rheumatic Fever is said to lick the joints but bites the Heart”
What is Strep throat?


Strep throat is caused by Group A Streptococcus (GAS)
bacteria
It is the most common bacterial infection of the throat
SIGNS & SYMPTOMS OF
STREP THROAT (GAS)



Symptoms may be mild or severe
Usually start to feel sick about 2- 5days after someone comes into
contact with the bacteria.
Symptoms can include
♥ Fever
♥ Red throat sometimes with white patches
♥ sore throat
♥ headache
♥ enlarged and tender lymph nodes in and around the
neck
♥ vomiting and abdominal complaints-especially in
children/tamariki
Strep throat



Most common in children between age 5 and 14, although anyone
can get it.
Those most at risk of developing Rheumatic Fever in NZ are
Maori and Pacific children between the ages of 5-14 years
Overcrowding - a lot of people living in the same household;
Spread by person-to-person contact with nasal secretions or saliva.
It commonly spreads among family or household members
Do all sore throats lead to
rheumatic fever?

Most sore throats are caused by a virus
and go away in a few days.

However, only a throat swab can tell
if the strep throat bacteria is present.

This is why sore throats matter

If a child or a young person complains of
a sore throat they should get checked by
a doctor or health professional
Why do sore throats
matter?





acute rheumatic fever and rheumatic heart disease (RHD) are a
consequence of untreated strep throat.
Children can be hospitalised on bed rest for weeks or months
Once diagnosed with rheumatic fever, a child has to receive a
painful injection every month for at least 10 years
The life span of tamariki affected is reduced, and cardiac surgery
may be necessary.
“ Families of children with RHD live with the emotional and
psychological cost of this disease. As these tamariki/children grow
with RHD their lives are needlessly shaped by the limitations that
RHD has the potential to place on them “
( O’Sullivan, 2011).
How can Rheumatic Fever be
prevented?





Most effective way is primary prevention . A whole community
working together.
How?
Key message - take all sore throats seriously
Rheumatic Fever is highest amongst children aged 5-14 years,
parents, teachers, health professionals and others in daily contact
with school children are well placed to promote awareness about
Rheumatic Fever
Schools take part in the Rheumatic Fever Prevention Programme
RHEUMATIC FEVER PREVENTION PROGRAMME: SORE
THROAT SWABBING SERVICE IN SCHOOLS


This is a joint venture between Ngati Porou Hauora (NPH),
Turanga Health and Tairawhiti District Health (TDH)
The throat swabbing programme in Tairawhiti will be delivered
by the NPH rural health team on the East Coast, the Well
Child Team (public health nurses) at TDH in the urban area,
and Turanga Health rural health team in the Western Rural
region of Tairawhiti
Why Tairawhiti?
Tairawhiti 15.1
Counties Manukau 11.6
Northland 10.8
Hawke’s Bay 5.8
Waikato 5.8
Hutt Valley 4.9
Waitamata 2
Auckland 2
All the rest <1

Annual rates of RF first
admissions by DHB in NZ per
100,000 population (1996-2005)
Jaine et al 2008
What Schools/Kura ?
All children between 5 and 14 years attending
deciles 1, 2 and some 3 schools will be offered the
throat swabbing programme.
 The
service will also be available
for
family/whanau members of children testing
positive for Group A Streptococcal (GAS)
pharyngitis

How does it work?
Child has a sore throat and tells school
 School notify parent and/or PHN
 PHN asks for consent to take throat swab
 Consent obtained by parent
 Throat swab taken
 Child may or may not be given antibiotics at the
time or there might be a wait for the swab
results; depends on assessment, parent/caregiver
 If the throat swab is positive the family/whanau
will be offered throat swabbing and antibiotics if
required
 Antibiotics are taken for 10 days

How will we know if we have
reduced the rate of Rheumatic
Fever in our community?
 Evaluation
of the programme
 Gradually less number of children with
positive results on swabbing
 Fall in number of cases of RF
References
Heart Foundation (2008). Evidence-based, best practice New Zealand
Guidelines for Rheumatic Fever: 2. Group A Streptococcal sore throat.
Auckland; Author.
Heart Foundation of NZ (2009). New Zealand Guidelines for Rheumatic
Fever: 3. Proposed Rheumatic Fever Primary Prevention Programme.
Auckland; Author.
Heart Foundation (2011). Fulfil a lifetime: Annual Report 2011. Auckland;
Author
Toi Te Ora Public Health Bay of Plenty DHB (n.d.). Rheumatic Fever Resource
Retrieved from http.//toiteorapublichealth.govt.nz
O’Sullivan, L. (2011) e Runanga o Te Rarawa Rheumatic Fever Reduction
Programme - Kaitaia; Journal of Primary Health Care; (3) pp 325-326