Rheumatic fever

Carapetis, J., and Couzos, S. (2008) Rheumatic fever. In: Couzos, Sophia, and Murray, Richard, (eds.) Aboriginal Primary Health Care: an evidence-based approach. Oxford University Press, South Melbourne, VIC, Australia, pp. 445-482.

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Acute rheumatic fever (ARF ) is an autoimmune disease, precipitated by infection with the group A streptococcus (GAS) bacterium. ARF leads to rheumatic heart disease (RHD) and is still a significant cause of cardiovascular morbidity and mortality in northern and central Australia, suffered almost exclusively by Aboriginal people. It is a classical disease of poverty, as overcrowding and difficulties in maintaining high standards of community as well as personal hygiene facilitate streptococcal infection and transmission. Primary prevention of ARF includes interventions to reduce circulating streptococci (including prevention and treatment of skin infections, improved housing, and hygiene infrastructure) and primary prophylaxis (treatment of streptococcal sore throat with penicillin). As yet there is no vaccine available to prevent ARF, and there is insufficient evidence to support the use of mass penicillin prophylaxis in its primary prevention. Secondary prophylaxis of ARF is the single most important prevention strategy. Benzathine penicillin G is the optimal choice of prophylactic agent, given every 4 weeks, although 3-weekly doses have been shown to offer superior rheumatic fever control. A coordinated control program, based around both local and centralised ARF and RHD registers, is the best way to improve benzathine penicillin G adherence rates and to ensure that those with RHD are identified and receive adequate clinical follow-up, including specialist review and echocardiography.

Item ID: 34140
Item Type: Book Chapter (Research - B1)
ISBN: 978-0-19-555138-9
Date Deposited: 16 Nov 2014 22:21
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 100%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920399 Indigenous Health not elsewhere classified @ 100%
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