Fighting against rheumatic fever in BOP
A new Bay of Plenty study has been published in the global Pediatric Infectious Disease Journal showing the effectiveness of Hauora led school based programmes with nurse and GP support, in the fight to stop rheumatic fever damaging young hearts.
Rheumatic fever is a serious but preventable illness mainly affecting Māori and Pacific children and young people (aged 4 to 19 years).
It usually starts with a sore throat that is known as ‘strep throat’ infection, and sometimes skin infection caused by the bacteria called Group A Streptococcus.
If they are not treated with antibiotics they can lead to rheumatic fever and serious heart problems.
The study write-up team comparing school programmes outcomes from 2011-2018 with the previous eleven years, was led by committed advocate for rural and Māori health, Whakatāne Hospital Paediatrician Dr John Malcolm.
Eastern Bay PHA Rheumatic Fever Nurse Sandra Innes-Smith set up the programmes with Hauora, the DHB and rural GP Dr Jo Scott-Jones.
Dr Liam Walsh now Paediatric Fellow in Dunedin also co-authored along with statistician Dr Janine Wright, Dr Richard Ngata now Paediatric Registrar at Waitematā, Dr Megan Tozer of Tauranga and three others including the late Professor Diana Lennon –a world renowned researcher who advocated tirelessly, both nationally and globally, for rheumatic fever prevention and control.
The retrospective study looked at three groups as follows:
• Rural Hauora school-based sore throat swabbing programmes with nurse and general practice (GP) support – Eastern Bay.
• Predominately GP services with a school-based programme in three high-risk schools – Western Bay.
• Solely GP delivered care - Whakatāne area.
In the Eastern Bay, school-based programmes are provided by Te Pou Oranga o Whakatōhea, Tūwharetoa ki Kawerau, Te Ika Whenua Hauora, Murupara, and Tuhoe Hauora.
In Tauranga Te Manu Toroa started, and public health nurses now provide the service for three Tauranga schools. Community Health Workers visit schools twice-weekly to educate and swab children’s sore throats, and support treatment when indicated.
Both rheumatic fever prevention programmes with a school-based component saw a decline in acute rheumatic fever cases during the study period.
The greatest drop of 60 per cent from a higher baseline was seen in the Eastern Bay and 48 per cent in the West.
The study found a greater decline for boys, who have greater Strep A throat carriage but present less often.
The drop was most marked in the Eastern Bay school-based programmes whereas the number of acute rheumatic fever (ARF) cases (particularly boys) doubled in the Whakatāne area with no school-based component during the study period.
Since 2018, sore throat swabbing programmes one day a week are being provided in some schools in the Whakatāne area.
Dr John Malcolm says the findings really highlight the importance and effectiveness of Hauora delivered school-based programmes with GP support in high ARF risk areas.
“They have started to ‘close the gaps’ particularly for Māori children but there is still a long way to go.”
Dr Malcolm says the study also found the programmes to be much more cost effective than a 2018 nationwide evaluation estimated.
“We looked for diagnostic accuracy in each notification and patient notes which the national evaluation could not do. This gave us a reliable consistent multi-sourced database as recommended.”
The COVID-19 lockdown earlier this year, saw a cluster in rheumatic fever cases amongst school age children in the Bay of Plenty.
In that period six paediatric cases of acute rheumatic fever were admitted to the Children’s wards including four cases in Whakatāne.
Paediatrician Dr John Malcolm says, “To put this in perspective, that’s about a year’s number of children being admitted to hospital with acute rheumatic fever in the space of eight weeks.
“The combination of Group A streptococcal throat infections, skin issues, crowded homes, and more home-time together with less access to school or community health care appear to have been contributing factors.”
School-based rheumatic fever prevention programmes have since resumed covering 38 Bay of Plenty schools; including most in the Eastern Bay identified as having a very high risk of rheumatic fever.
Some pharmacies are offering free sore throat swabs from 4-19 years of age and family practices are back delivering full services.
Dr Malcolm says there can be life-long consequences for tamariki and their whānau who have damaged hearts from rheumatic heart disease.
“All sore throats and skin infections matter. That is why the BOPDHB is adding Kiri Ora (healthy skin checks) alongside its strep sore throats rheumatic fever prevention programmes. The teams also make healthy housing referrals resulting in warmer and drier homes.
Contact details and a schedule of school-based sore throat swabbing programmes in the BOPDHB region can be found here: https://www.toiteora.govt.nz/vdb/document/2176