This RHD prevalence was as high as lower middle-income African countries, the researchers found. Uganda had a similar prevalence rate, but the disease severity there was substantially lower than what was found in the South Auckland study of 465 16–40-year-olds over two years.
The majority of RHD cases in the study had moderate or severe disease, highlighting major deficiencies in existing healthcare services for underserved and socioeconomically deprived New Zealand populations, the researchers said.
Rheumatic heart disease occurs when heart valves are permanently damaged by one or more bouts of rheumatic fever. Rheumatic fever is an autoimmune inflammatory reaction to the common throat infection from streptococcus pyogenes (group A streptococcus), most often referred to as strep throat. It is an illness which can be passed on in a similar way to other upper respiratory tract infections.
Prevention of RHD involves preventing the spread of strep infections or treating them with antibiotics when they occur. It is a preventable disease which had been eradicated in many parts of the world by the middle of last century, but not here.
Here, Māori and Pasifika children aged 4 to 19 have the highest rates of rheumatic fever.
Recent news reports suggesting the illness may be on the rise among Māori and Pasifika children in Manukau is depressing, but not surprising, given the crowded living conditions many families endure.
In its information on rheumatic fever, health agency Te Whatu Ora says it is "highly likely" a combination of crowded housing conditions and socio-economic deprivation, barriers to primary healthcare access and the subsequent higher burden of untreated strep sore throat infections are important factors leading to the high rates for Māori and Pasifika children.
While we have known about this disease for decades and that its burden will be felt by Māori and Pacific communities and our health services for decades to come, we have had limited success with a variety of initiatives to reduce the rate of rheumatic fever.
Any vaccine which is developed should not be seen as an excuse to avoid addressing the multiple issues which arise from poor housing and access to good healthcare.
The Government has been funding some rheumatic fever prevention in recent years and has been working on a five-year Rheumatic Fever Roadmap which would set out "priority actions and opportunities for investment and action in coming years".
The Te Whatu Ora website said it anticipated publishing this plan early this year but a check with the agency revealed this is expected to be launched in mid-June.
A comprehensive co-ordinated approach to this disease cannot come soon enough.
Theoretically, the opportunity to organise such an approach and ensure it is carried through should be enhanced as a result of the health system reforms.
If it succeeded, what a great poster child for the new system it would be.
In the current climate, with its short-staffing of all health services, including primary care, a vital part of any prevention programme, it is difficult to see this happening quickly.
We could and should have done better with this disease years ago.
It is hard not to agree with children’s heart specialist Dr Nigel Wilson, who said in 2009, if rheumatic fever was occurring unabated in St Heliers, Karori and Fendalton it would undoubtedly be a major public health issue.
