rheumatic fever in new zealand - university of otago · acute rheumatic fever first admission rate...
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Rheumatic Fever in New Zealand Otago Summer School 2016
Dr Catherine Jackson
Public Health Medicine Specialist
Medical Officer of Health
Disappearing Disease?
Chicago 1969-1977 Copenhagen 1862-1962
Shulman S T et al. Clin Infect Dis. 2006;42:441-447
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1860 1960 1900 1940 1880 1920
Denny F. Clin Infect Dis. 1994;19:1110-1122
NZ in a Global Context 2010-2012
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MarketEconomies
New Zealand NZ Māori NZ Pacific
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New Zealand Data Sources
Data Source Strengths Weaknesses
Hospital Admissions National data
Ministry algorithm
• Over-estimates by 20-33%
• Review clinical notes for
accuracy
ESR Surveillance National data
• Under-estimated by 20-50%
before 2013 – DHBs vary
• Improved since 2013
• May be accuracy issues
Rheumatic Fever
Registers Accurate diagnosis • Regional not national
Be aware – numbers and rates vary by data source
New Zealand Trends
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Hospital Admissions due to Acute Rheumatic Fever in Children and Young People 0-24 Years, New Zealand
1990-2007
MOH: 0-30 year olds
NZCYES: 0-24 year olds
Ministry of Health. Progress on Health Outcome Targets 1999. Wellington: Ministry of Health; 1999.
New Zealand Child and Youth Epidemiology Service www.otago.ac.nz/nzcyes
Acute Rheumatic Fever Hospitalisations 1970-2010
Secondary
prophylaxis
National Burden 2006-2010
Acute Rheumatic Fever
first admission rate 4 per 100,000
~150 first admissions per year (~180 in 2011-13)
~1,500 children and young people on prophylaxis
(in Auckland Region ~1,000)
Rheumatic Heart Disease
~550 hospital admissions per year
~140 deaths - Average age 56-58 yrs for Pacific/Māori
and 80 yrs for Other
North-South
Gradient
ARF Admissions 2006-10
0-24 Year Olds
Rate per 100,000
New Zealand Child and Youth Epidemiology
Service www.otago.ac.nz/nzcyes
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16 - 25
>25
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Hospital Admissions due to Acute Rheumatic Fever in Children and Young People 0-24 Years, New Zealand
1990-2007
NZCYES 2012 www.otago.ac.nz/nzcyes
ARF Admissions by Age 0-24 Year Olds, NZ 2006-2010
ARF Admissions by Ethnicity 0-24 Year Olds, NZ 2006-2010
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Hospital Admissions due to ARF in Children and Young People 0-24 Years by Ethnicity, New Zealand
2000-2010
Pacific Maori European Asian / Indian
NZCYES 2012 www.otago.ac.nz/nzcyes
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Decile 1-2 Decile 3-4 Decile 5-6 Decile 7-8 Decile 9-10
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Hospital Admissions due to ARF in Children and Young People 0-24 Years by Ethnicity, New Zealand
2000-2010
NZCYES 2012 www.otago.ac.nz/nzcyes
ARF Admissions by Deprivation 0-24 Year Olds, NZ 2006-2010
Better Public Services Target
• Reduce the incidence of first episodes of
acute rheumatic fever by two thirds
• From 4.2 per 100,000 (2010/11)
to 1.4 per 100,000 by June 2017
reduction in the total population
hospital admission rate
http://www.health.govt.nz/about-ministry/our-priorities/better-public-services
What has happened since?
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First episode rheumatic fever hospitalisation rate
Māori and Pacific
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National Māori Pacific
First episode rheumatic fever hospitalisation rate
Auckland Region 60% of Cases
Improving Surveillance Data since 2013
– Quarterly admissions data from DHBs
(monthly for CMDHB)
– Quarterly reports back to the DHBs
– Possible cases followed up until definitive
diagnosis made
– Ensure all cases referred to Regional RF
Register
Auckland Region Notifications 0-19 year olds
Auckland Region Notifications Māori and Pacific 0-19 year olds
Susceptible Host
Environment Group A Strep
RF
Type of GAS?
Carriage?
Transmission?
Community load?
Genetic?
Perinatal infection?
Screening test?
Housing quality?
Household
composition?
Income?
Crowding?
Access to healthcare?
Deprivation?
Nutrition?
Primary Prevention Access Sore Throat Treatment
Baltimore Study 1960s
– Improving access to healthcare reduced ARF
– Gordis L NEJM 1973;289(7):331-335
• Rationale behind school programmes,
rapid response clinics and free primary
care to <13’s
NZ Health Survey 2014/15 Children 0-14 years
Unmet need for GP care
– 27% Māori, 27% Pacific, 21% European/Other
– No significant change since 2011/12
– Barriers: No appt in 24 hours > cost > transport
> childcare
Unfilled Prescription due to cost
– Pacific (14%), Maori (9.2), European (3.5%)
– No significant change since 2011/12
Household Crowding* 0-14 year olds, 2013 Census
05
101520253035404550
Euro
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Ethnicity NZ Deprivation Decile
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• No significant change since 2001 Census *requires 1+ additional bedrooms
Conclusions
• Among world’s highest rates of RF in NZ
but declining
• Burden is borne by Māori and Pacific
– Premature death from RHD
– 1,500 on monthly penicillin injections
– 550 admissions for rheumatic heart disease
– 140 deaths annually
• Environmental drivers complicated
ARF Admissions per Month 0-24 Year Olds, NZ 2006-2010
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Hospital Admissions due to ARF in Children and Young People 0-24 Years by Ethnicity, New Zealand
2000-2010
NZCYES 2012 www.otago.ac.nz/nzcyes
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