An outbreak of acute rheumatic fever in a remote Aboriginal community

Natasha Egoroff, Hilary Bloomfield, Wanamula Gondarra, Brando Yambalpal, Terrence Guyula, Demi Forward, Gemma Lyons, Emer O’Connor, Lou Sanderson, Michelle Dowden, Desley Williams, Jessica Langloh De Dassel, Pasqualina Coffey, Elizabeth Rrapa Dhurrkay, Veronica Gondarra, Deborah Holt, Vicki L. Krause, Bart John Currie, Kalinda Griffiths, Karen DempseyAnna Glynn-Robinson

Research output: Contribution to journalArticlepeer-review

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Abstract

Objectives: We describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. Methods: In August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. Results: 12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. Conclusions: This outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. Implications for Public Health: Outbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management.

Original languageEnglish
Article number100077
Pages (from-to)1-7
Number of pages7
JournalAustralian and New Zealand Journal of Public Health
Volume47
Issue number5
Early online dateAug 2023
DOIs
Publication statusPublished - Oct 2023

Bibliographical note

Funding Information:
The remote setting is complex, and resources are constrained. Acute and primary care clinics currently do not have funding or capacity to deliver consistent outreach services targeting days-at-risk; however, this is considered critical to the prevention of ARF recurrences. Sustainable and dedicated ARF and RHD program funding continues to be a challenge. At the time of the outbreak, the three-year Rheumatic Fever Strategy (RFS) funding provided by the Australian Government to MHAC had ceased on 30 June 2021. This was followed by a funding gap of over one year. A 2021 independent evaluation of the RFS identified that “stability in leadership and staffing is critical” to the success of the RFS.40 In this setting, inconsistent funding continues to negatively affect stability in leadership and staffing.

Publisher Copyright:
© 2023 The Authors

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