First Presentation Acute Rheumatic Fever is Preventable in a Community Setting: A School-based Intervention

Area of Science:

• Public Health
• Infectious Disease Prevention
• Pediatric Cardiology

Background:

• Limited evidence exists for community-based programs aimed at preventing initial acute rheumatic fever (ARF) cases through timely treatment of group A streptococcal (GAS) pharyngitis.
• Acute rheumatic fever remains a significant public health concern, particularly in certain pediatric populations, necessitating effective prevention strategies.

Purpose of the Study:

• To evaluate the impact of implementing a school-based sore throat clinic program on the incidence of first-time ARF presentations among school-aged children.
• To assess changes in pharyngeal group A streptococcal (GAS) prevalence following the introduction of the intervention.

Main Methods:

• A school-based sore throat clinic program was introduced in Auckland, New Zealand, covering approximately 25,000 students aged 5-13 years across 61 schools from 2010-2016.
• Culture-proven GAS pharyngitis cases identified by nurses and lay workers were treated with amoxicillin. ARF incidence was determined using a population-based register, and pharyngeal GAS prevalence was monitored annually in a subset of students.
• A generalized linear mixed model was employed to analyze ARF rate changes before and after the staggered implementation of the school clinics.

Main Results:

• Following the introduction of school clinics, ARF rates in 5-13 year olds decreased by 58%, from 88 to 37 per 100,000 children within two years.
• Statistical analysis revealed no significant change in ARF rates before the clinic's introduction (P = 0.88), but a significant decline after its implementation (P = 0.008).
• Pharyngeal GAS prevalence decreased significantly from 22.4% pre-intervention to 11.9% and 11.4% in the subsequent one to two years (P = 0.005).

Conclusions:

• School-based management of group A streptococcal pharyngitis, utilizing oral amoxicillin, led to a significant reduction in acute rheumatic fever incidence.
• The observed decline in ARF rates was concurrent with a decrease in pharyngeal GAS prevalence, supporting the program's effectiveness in disease prevention.