A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence

Joshua R. Francis, Catherine Gargan, Bo Remenyi, Anna P. Ralph, Anthony Draper, Deborah Holt, Vicki Krause, Kate Hardie

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objectives: We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting.

Methods: The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Household contacts were screened for ARF or group A Streptococcus (GAS) infection by questionnaire and swab collection, offered an echocardiogram if aged 5–20 years, and intramuscular benzathine benzylpenicillin if aged over one year or if less than one year with impetigo.

Results: Fifteen definite and seven probable ARF cases were diagnosed in the community in July–December 2014 (all-age incidence of definite ARF: 1,473/100,000). The public health response identified two additional cases of ARF. A total of 81 contacts were screened; GAS was detected in 3/76 (4%) throat swabs and 11/24 (46%) skin swabs. Molecular typing revealed high GAS strain diversity.

Conclusions: The incidence of ARF during this cluster was very high. Carriage and infection with GAS was observed, but no outbreak strain identified.

Implications for public health: A national public health guideline has since been developed that includes advice on the investigation of an ARF outbreak/cluster. Sustained efforts with strong community engagement are required to tackle high ARF rates.

Original languageEnglish
Pages (from-to)288-293
Number of pages6
JournalAustralian and New Zealand Journal of Public Health
Volume43
Issue number3
DOIs
Publication statusE-pub ahead of print - 17 Apr 2019

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Rheumatic Fever
Incidence
Streptococcus
Public Health
Disease Outbreaks
Penicillin G Benzathine
Impetigo
Molecular Typing
Pharynx
Infection
Guidelines
Skin

Cite this

Francis, Joshua R. ; Gargan, Catherine ; Remenyi, Bo ; Ralph, Anna P. ; Draper, Anthony ; Holt, Deborah ; Krause, Vicki ; Hardie, Kate. / A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence. In: Australian and New Zealand Journal of Public Health. 2019 ; Vol. 43, No. 3. pp. 288-293.
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abstract = "Objectives: We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting. Methods: The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Household contacts were screened for ARF or group A Streptococcus (GAS) infection by questionnaire and swab collection, offered an echocardiogram if aged 5–20 years, and intramuscular benzathine benzylpenicillin if aged over one year or if less than one year with impetigo. Results: Fifteen definite and seven probable ARF cases were diagnosed in the community in July–December 2014 (all-age incidence of definite ARF: 1,473/100,000). The public health response identified two additional cases of ARF. A total of 81 contacts were screened; GAS was detected in 3/76 (4{\%}) throat swabs and 11/24 (46{\%}) skin swabs. Molecular typing revealed high GAS strain diversity. Conclusions: The incidence of ARF during this cluster was very high. Carriage and infection with GAS was observed, but no outbreak strain identified. Implications for public health: A national public health guideline has since been developed that includes advice on the investigation of an ARF outbreak/cluster. Sustained efforts with strong community engagement are required to tackle high ARF rates.",
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A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence. / Francis, Joshua R.; Gargan, Catherine; Remenyi, Bo; Ralph, Anna P.; Draper, Anthony; Holt, Deborah; Krause, Vicki; Hardie, Kate.

In: Australian and New Zealand Journal of Public Health, Vol. 43, No. 3, 17.04.2019, p. 288-293.

Research output: Contribution to journalArticleResearchpeer-review

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