RHEUMATIC FEVER PREVENTION PROGRAMME: SORE THROAT SWABBING SERVICE IN SCHOOLS

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RHEUMATIC FEVER PREVENTION PROGRAMME SORE THROAT
SWABBING SERVICE IN SCHOOLS

• He korokoro ora
• He manawa ora
• Mo tatou katoaA healthy throat,
• a healthy heart for us all
• Karen Clarke Public Health Nurse 2012

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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?
  

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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)

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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

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What is Strep throat?

• Strep throat is caused by Group A Streptococcus
  (GAS) bacteria
• It is the most common bacterial infection of the
  throat

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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

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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

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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

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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
• ( OSullivan, 2011).
  
  

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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

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RHEUMATIC FEVER PREVENTION PROGRAMME SORE 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

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Why Tairawhiti?
Tairawhiti 15.1
Counties Manukau 11.6
Northland 10.8
Hawkes Bay 5.8
Waikato 5.8
Hutt Valley 4.9
Waitamata 2
Auckland 2
All the rest lt1

• Annual rates of RF first admissions by DHB in NZ
  per 100,000 population (1996-2005) Jaine et al
  2008

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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

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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

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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

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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.//toiteorapublicheal
  th.govt.nz
• OSullivan, L. (2011) e Runanga o Te Rarawa
  Rheumatic Fever Reduction
  
• Programme - Kaitaia Journal of Primary
  Health Care (3) pp 325-326