Māori in New Zealand, particularly those living in the upper North Island, have
one of the highest rates of acute rheumatic fever and rheumatic heart disease in the world.1 For those of us
who live and practise in other parts of the country, rheumatic fever is a disease found only in textbooks or in older
people with valvular heart disease, resulting from acute rheumatic fever some 50 to 60 years ago. Both acute rheumatic
fever and rheumatic heart disease are largely preventable diseases.
In 2006, there were 103 cases of acute rheumatic fever in New Zealand, with a population rate of 2.5 per 100,000.2 Māori
accounted for 62% of these cases and 89% were under the age of 20 years.
The main factors contributing to these high rates are outlined in the recently developed New Zealand guidelines and
- Overcrowded living conditions
- Socioeconomic deprivation
- An increased incidence of pharyngitis with group A streptococcus
- Decreased access to appropriate and effective healthcare
There is clear evidence that people on low incomes are more at risk especially if living in overcrowded environments.
Māori are more likely to be over represented in this demographic.
In addition to higher rates of acute rheumatic fever and rheumatic heart disease, Māori also have higher rates
of recurrence, and with every recurrent episode the risk of permanent heart damage is increased. There is no evidence
of a genetic susceptibility of Māori to rheumatic fever.3
It is important for GPs to maintain a high degree of suspicion of acute rheumatic fever within high risk groups. Children
of European or Asian ethnicity and children living in the South Island rarely contract the illness.
There is currently no vaccine for group A streptococcus in New Zealand. Vaccines are being developed but, as there are
many serotypes of streptococcus, they are not universal.
The main task of the GP is to suspect the condition and then refer to secondary care for confirmation of the diagnosis
For more details on diagnosing and treating rheumatic fever, refer to the "New Zealand Guidelines for Rheumatic Fever",
available from: http://www.nhf.org.nz/files/Rheumatic
fever guideline 1.pdf
What is acute rheumatic fever?
Acute rheumatic fever arises from an auto-immune response to group A Streptococcus infection, usually from the upper
respiratory tract. There is, on average, a latent period of three weeks between the initial infection and the development
of acute rheumatic fever.
Acute rheumatic fever consists of an acute widespread inflammatory response that affects the heart, joints, skin
and brain. The heart (specifically the mitral and/or aortic valves) is the only organ that suffers long term damage.
Premature death is the ultimate consequence of rheumatic heart disease.