Hempenstall, Allison, Howell, Erin, Kang, Katherine, Chau, Ken W.T., Browne, Amylou, Kris, Ella, Wapau, Hylda, Pilot, Pelista, Smith, Simon, Reeves, Benjamin, and Hanson, Joshua (2021) Echocardiographic screening detects a significant burden of Rheumatic Heart Disease in Australian Torres Strait Islander children and missed opportunities for its prevention. American Journal of Tropical Medicine and Hygiene, 104 (4). pp. 1211-1214.

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Abstract

Rheumatic heart disease (RHD) is almost entirely preventable, but its incidence in indigenous Australians remains one of the highest in the world. A community-based echocardiogram screening program of 862 Torres Strait Islander children identified 25 (2.9%) new cases of RHD. Among these 25 children, 5/7 (71%) prior acute rheumatic fever presentations had not been recognized. There was a history of microbiologically confirmed group A Streptococcus infection in 17/25 (68%) children with RHD compared with 9/25 (36%) controls (odds ratio [OR] [95% CI]: 3.78 [1.17–12.19], P = 0.03). This was more likely to be a skin swab (16/25 [64%] cases versus 6/25 [24%] controls) than a throat swab (1/25 [4%] cases versus 3/25 [12%] controls) (OR [95% CI]: 5.33 [1.51–18.90] [P = 0.01]), supporting a role for skin infection in RHD pathogenesis. Household crowding and unemployment were common in the cohort, emphasizing the need for prioritizing strategies that address the social determinants of health.

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