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Rheumatic fever in the Kimberley region of Western Australia
1Rural Paediatric Service, West Perth, Western Australia.
Insights
Acute rheumatic fever (ARF) is a significant health issue in Western Australia's Kimberley region, particularly affecting Aboriginal children. High recurrence rates underscore the need for improved prevention strategies.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Acute rheumatic fever (ARF) remains a concern in remote Australian populations.
- Understanding ARF incidence and presentation is crucial for targeted interventions.
Purpose of the Study:
- To determine the incidence and clinical features of ARF in children and young adults (<30 years) in Western Australia's Kimberley region.
- To identify high-risk populations within this demographic.
Main Methods:
- A five-year retrospective study (1988-1992) reviewed hospital and clinic records.
- Identified cases meeting the revised Jones criteria for ARF.
- Calculated incidence rates stratified by age and ethnicity.
Main Results:
- 96 ARF cases were identified, with 80% of affected individuals being of Aboriginal descent.
- Overall ARF incidence was 136 per 100,000, significantly higher (241 per 100,000) in the Aboriginal population.
- Aboriginal school children (5-14 years) faced the highest risk with an incidence of 375 per 100,000.
- Common presentations included carditis (50%), polyarthritis (59%), and chorea (22%).
- Rheumatic heart disease (RHD) developed in 31 cases, with one fatality.
Conclusions:
- ARF is a major health problem in the Kimberley's Aboriginal population.
- High recurrence rates highlight challenges with secondary prophylaxis.
- Urgent public health strategies are needed to reduce ARF burden and prevent RHD.
Abstract:
The objective of this study was to assess the incidence and clinical presentation of acute rheumatic fever in children and young adults in the north west of Western Australia--a region known as the Kimberley. In this five year retrospective study, residents aged less than 30 years, suspected of having had acute rheumatic fever from 1988 to 1992, were identified and their hospital and clinic records were reviewed. There were 96 cases of acute rheumatic fever that met the revised Jones criteria during the five year period. There were 59 initial attacks and 37 recurrences that occurred in 81 people, of whom 80 were of Aboriginal descent. The overall incidence of acute rheumatic fever in the Kimberley region for those aged under 30 years is 136 cases per 100,000 per year and in the Aboriginal population is 241 per 100,000 per year. The group most at risk are Aboriginal school children aged 5-14 years who accounted for 50 cases and have an annual incidence of 375 cases per 100,000 per year. The clinical presenting features were carditis in 50 per cent, polyarthritis in 59 per cent, chorea in 22 per cent, and subcutaneous nodules in 1 per cent. The hospitalization rate was 80 per cent for new cases and 73 per cent for recurrences with average stays of 14.6 and 1.5 days respectively. Rheumatic heart disease (RMD) developed in 31 of the cases; two required surgery and there was one death attributable to RHD in this group. Rheumatic fever continues to be a significant health problem in the Aboriginal population in this region and the recurrence rate, despite secondary prophylaxis, is also unacceptably high.