Rheumatic fever, syphilis cases rise Thursday, 15 January 2015

Source:  Andrea Vance

Rheumatic fever rates are on the up despite $65 million being spent on prevention, new figures reveal.

A report by crown research unit ESR (Environmental Science and Research) shows a "significant increase" in cases of the disease in the year to September, with 235 notified acute cases, up 75 on the previous 12 months.

The fever is an inflammation of the heart, which can leave scarring on valves, and is linked to poverty, poor and overcrowded housing, and a lack of access to healthcare.

Maori and Pasifika children aged 5-14 years are most at risk. 

The Government has pumped resources into the combating the illness with free drop-in clinics, healthy homes initiatives and public information campaigns, and wants to reduce incidences by two-thirds by June 2017.

Labour's health spokeswoman Annette King said the Government was failing with rates of the disease rising in the last three years.

One child a week, with a heart badly damaged by the fever, underwent surgery at Starship children's hospital in Auckland, she said.

Estimates put 140 adult deaths a year down to the illness.

"As former health minister Tony Ryall himself said: 'We are the only developed country in the world with levels of rheumatic fever you would see in the third world'," King said.

She wanted the Government to tackle the causes.

Acute rheumatic fever is largely a disease of poverty, overcrowding, and healthcare inequality," she said.

"Preventing it requires more than throat-swabbing and publicity campaigns, it requires a health system that provides services that are accessible for all and a co-ordinated effort to address social factors that impact on health, such as housing."

Health Minister Jonathan Coleman referred questions to his ministry.

Dr Chrissie Pickin, who leads the health ministry's rheumatic fever programme, said notified cases of acute rheumatic were not the best way to measure progress on stamping out the disease. 

"We know that there can be considerable volatility in cases reported year on year. A case reported in 2014 could have actually been diagnosed in prior years. Almost a quarter (23%) of the cases reported in 2014 occurred in earlier years." 

Instead, officials focussed on cases where patients were sent to hospital. "The most recent hospitalisation data available is from July 2013 to June 2014 and shows a slight decrease. Updated data is currently being finalised and is expected to show a further decrease in hospitalisation rates," she said.

Green party health spokesman Kevin Hague echoed King's comments, saying it was "ridiculous" to set a target to reduce rates while refusing to put one in place to tackle child poverty.

"Rheumatic fever is a disease of poverty," he said. "The most deprived kids are almost 30 times as likely to get the disease."

However, he said throat-swabbing clinics were "important" in improving access to health care.

The ESR figures also show a significant increase in measles, hepatitis, Hib disease (a flu that affects children), yersiniosis (a type of gastroenteritis), dengue fever and chikungunya fever, a viral disease transmitted by mosquitoes.

By contrast, cases of cryptosporidiosis, malaria, meningococcal disease, poisoning from toxic shellfish and salmonella, whooping cough and e-coli infections were down in the same period. 

ESR was also monitoring syphilis rates after the number of cases soared between 2002 and 2009.

There were 81 reported infectious cases, up from 72 identified in 2011. Officials noted their statistics came only from family planning and sexual health clinics and did not include those treated by GPs and other healthcare providers.

The report said that between 2011 and 2013 cases were concentrated among men who had sex with men living in the main population centres.

The highest numbers were in Auckland and Christchurch.

In 2013 73 out of the 81 cases were men, with 86.3 per cent among gay men.

The highest number of cases was in the 45-49 age group. The report noted concerns that some women remained undiagnosed as most cases were discovered from health checks and screening rather than because of symptoms. 

Also analysed in the report is an outbreak of typhoid in an extended family in Auckland. Five people aged between 5 and 63, in eight homes contracted the disease between November 2013 and March 2014. 

Recent visitors from Tonga and Samoa had brought raw fish, sea slugs, cooked yams and raw coconuts.

"The self-reported Pacific foods were recognised as potential sources of infection for the outbreak," it said.

RHEUMATIC FEVER

* 235 cases in the year to September 2014, up from 160 in the previous year

* Three were in children aged between 1-4 years old

* 19 were in children aged between 5-9

* 22 in ages between 10-14

* 34 cases in those aged 15 and over

* 68 cases were acute, 10 were recurrent