RHEUMATIC FEVER PREVENTION PROGRAMME: SORE THROAT SWABBING

SERVICE IN SCHOOLSHe korokoro oraHe manawa oraMo tatou katoa

A healthy throat,a healthy heart for us all

Karen Clarke Public Health Nurse 2012

Topics Covered Overview of Rheumatic Fever in New

Zealand What is Rheumatic Fever ? What is strep throat ? Signs and Symptoms of Strep throat (GAS) Do all sore throats lead to Rheumatic Fever? Why do sore throats matter? How can Rheumatic Fever be prevented? What is the Rheumatic Fever prevention

programme?

Rheumatic Fever in New Zealand: An Overview

Rheumatic Fever is still common in NZ, even though it has virtually disappeared in other industrialised countries.

It mainly occurs in Maori and Pacific children, in lower socioeconomic areas of the North Island.

Rheumatic Fever is closely related to poverty and crowded housing

“The cost for rheumatic fever for the individuals affected, their families and communities and the health sector is very

high…. It casts a long shadow” (Sharpe, 2011, p12)

WHAT IS RHEUMATIC FEVER?

Rheumatic Fever is serious preventable disease that can cause permanent heart damage.

It often starts with a sore throat (a streptoccocal infection) A few weeks after a child may develop:

▪ sore or swollen joints (knees, elbows, ankles and wrists)

▪ a skin rash

▪ a fever

▪ stomach pain

▪ jerky movements

Heart damage can develop immediately, or within a few months.

“Rheumatic Fever is said to lick the joints but bites the Heart”

What is Strep throat? Strep throat is caused by Group A Streptococcus (GAS)

bacteria It is the most common bacterial infection of the throat

SIGNS & SYMPTOMS OF STREP THROAT (GAS)

Symptoms may be mild or severe Usually start to feel sick about 2- 5days after someone comes into

contact with the bacteria. Symptoms can include

♥ Fever

♥ Red throat sometimes with white patches

♥ sore throat

♥ headache

♥ enlarged and tender lymph nodes in and around the neck

♥ vomiting and abdominal complaints-especially in children/tamariki

Strep throat Most common in children between age 5 and 14, although anyone

can get it. Those most at risk of developing Rheumatic Fever in NZ are Maori

and Pacific children between the ages of 5-14 years Overcrowding - a lot of people living in the same household;

Spread by person-to-person contact with nasal secretions or saliva. It commonly spreads among family or household members

Do all sore throats lead to rheumatic fever?

Most sore throats are caused by a virus

and go away in a few days. However, only a throat swab can tell

if the strep throat bacteria is present.

This is why sore throats matter If a child or a young person complains of

a sore throat they should get checked by

a doctor or health professional

Why do sore throats matter?

acute rheumatic fever and rheumatic heart disease (RHD) are a consequence of untreated strep throat.

Children can be hospitalised on bed rest for weeks or months Once diagnosed with rheumatic fever, a child has to receive

a painful injection every month for at least 10 years The life span of tamariki affected is reduced, and cardiac

surgery may be necessary. “ Families of children with RHD live with the emotional and

psychological cost of this disease. As these tamariki/children grow with RHD their lives are needlessly shaped by the limitations that RHD has the potential to place on them “

( O’Sullivan, 2011).

How can Rheumatic Fever be prevented?

Most effective way is primary prevention . A whole community working together.

How? Key message - take all sore throats seriously Rheumatic Fever is highest amongst children aged 5-14

years, parents, teachers, health professionals and others in daily contact with school children are well placed to promote awareness about Rheumatic Fever

Schools take part in the Rheumatic Fever Prevention Programme

RHEUMATIC FEVER PREVENTION PROGRAMME: RHEUMATIC FEVER PREVENTION PROGRAMME: SORE THROAT SWABBING SERVICE IN SCHOOLSSORE THROAT SWABBING SERVICE IN SCHOOLS

This is a joint venture between Ngati Porou Hauora (NPH), Turanga Health and Tairawhiti District Health (TDH)

The throat swabbing programme in Tairawhiti will be delivered by the NPH rural health team on the East Coast, the Well Child Team (public health nurses) at TDH in the urban area, and Turanga Health rural health team in the Western Rural region of Tairawhiti

Why Tairawhiti?Tairawhiti 15.1

Counties Manukau

11.6

Northland 10.8

Hawke’s Bay 5.8

Waikato 5.8

Hutt Valley 4.9

Waitamata 2

Auckland 2

All the rest <1 Annual rates of RF first

admissions by DHB in NZ per 100,000 population (1996-2005) Jaine et al 2008

What Schools/Kura ?

All children between 5 and 14 years attending deciles 1, 2 and some 3 schools will be offered the throat swabbing programme.

The service will also be available for family/whanau members of children testing positive for Group A Streptococcal (GAS) pharyngitis

How does it work? Child has a sore throat and tells school School notify parent and/or PHN PHN asks for consent to take throat swab Consent obtained by parent Throat swab taken Child may or may not be given antibiotics at

the time or there might be a wait for the swab results; depends on assessment, parent/caregiver

If the throat swab is positive the family/whanau will be offered throat swabbing and antibiotics if required

Antibiotics are taken for 10 days

How will we know if we have reduced the rate of

Rheumatic Fever in our community?

Evaluation of the programme Gradually less number of children with

positive results on swabbing Fall in number of cases of RF

References

Heart Foundation (2008). Evidence-based, best practice New Zealand

Guidelines for Rheumatic Fever: 2. Group A Streptococcal sore throat.

Auckland; Author.

Heart Foundation of NZ (2009). New Zealand Guidelines for Rheumatic

Fever: 3. Proposed Rheumatic Fever Primary Prevention Programme.

Auckland; Author.

Heart Foundation (2011). Fulfil a lifetime: Annual Report 2011. Auckland;

Author

Toi Te Ora Public Health Bay of Plenty DHB (n.d.). Rheumatic Fever Resource

Retrieved from http.//toiteorapublichealth.govt.nz

O’Sullivan, L. (2011) e Runanga o Te Rarawa Rheumatic Fever Reduction

Programme - Kaitaia; Journal of Primary Health Care; (3) pp 325-326