The epidemiology of acute rheumatic fever in Northland, 2012-2017

The aim of the audit was to establish the accuracy and completeness of surveillance of acute rheumatic fever (ARF) in Northland for the period 2012-2017 and to compare the rates of ARF with the previous audit.

Cases of ARF were identified and evaluated through the national surveillance database (EpiSurv), the Northland Rheumatic Fever secondary prophylaxis register and hospital discharges. Cases were included if they were Northland residents and met the ARF diagnostic criteria as per the 2014 New Zealand Heart Foundation guidelines.

A total of 69 ARF cases met audit criteria, an annualised incidence rate of 7.0/100,000. Ninety-three percent of cases were Māori. The 5-14 year age group had the highest rates, which also demonstrated the greatest disparity between Māori (64.5/100,000), Pacific (54.6/100,000) and non-Māori/non-Pacific (1.5/100,000). ARF was strongly associated with level of deprivation, with 87% of cases in NZDep8-10.

ARF surveillance in Northland appears comprehensive with only minor discrepancies identified between data sets. ARF rates among Northland Māori aged 5-14 years (64.5/100,000) remain similar to those seen in low-income countries. For Māori, an improvement from the previous audit of only one-fifth was seen despite the Rheumatic Fever Prevention Programme. The Ministry of Health's recent publications indicate a large improvement in ARF rates for Northland. However, these findings do not correlate with the results of this audit. This audit highlights the significant, ongoing need in Northland for ARF prevention efforts.