Rheumatic Fever Research Partnership to fund four projects Monday, 16 December 2013

HRC Press Release

The Health Research Council of New Zealand (HRC) has announced funding for four research projects that aim to develop a better understanding of the most effective approaches to reduce the incidence and impact of rheumatic fever in New Zealand, with the projects due to be completed in late 2016.

These projects have been funded through the Rheumatic Fever Research Partnership, a joint initiative between the Heart Foundation, Cure Kids, Te Puni Kōkiri, the Ministry of Health and the HRC.

Professor Michael Baker from the University of Otago will lead a research project which will use a case-control study to compare cases of RF (150) with controls who do not have the disease, to identify important risk factors for rheumatic fever. Cases and controls will be interviewed about such factors as housing conditions, crowding, tobacco smoke exposure, treatment of sore throats, skin infections, and oral health. Throat swabs will be tested for the streptococcus bacteria that cause rheumatic fever. Blood specimens will be collected for vitamin D, iron stores, and other factors. At the end of the study, researchers expect to identify important risk factors for rheumatic fever, particularly those that are modifiable. This information will be used to guide prevention programmes to help lower rates of rheumatic fever in New Zealand and internationally.

Professor Julian Crane from the University of Otago will lead a study which will measure the effect of an oral probiotic, Strep salivarius (a healthy naturally occurring bacteria that is found normally in the mouths of some children) to prevent Group A Streptococcal (GAS) sore throat in a population at high risk of rheumatic fever. Children who naturally have these bacteria in their mouths have less GAS sore throat. The Ministry of Health sore throat treatment programme currently running in East Porirua schools, in children aged 5-14 years, provides a unique opportunity to test whether this natural product currently available in pharmacies (and made in New Zealand) can reduce GAS sore throat. A small pilot study has shown a 90 per cent reduction in GAS sore throat in high risk populations but no formal blinded randomised trial has previously been undertaken.

If effective, this strategy could be incorporated immediately into the prevention of GAS sore throat occurring in all high risk populations in New Zealand.

In New Zealand, sore throat clinics in schools are underway to control rheumatic fever by treating the preceding Group A Streptococcal (GAS) sore throat. To ensure the best outcome for children, Professor Diana Lennon from the University of Auckland will examine the success of different school programmes. The amount of GAS, both from skin and throat infections, will be measured before and after the commencement of school clinics. The research project will also compare different initiatives that might reduce GAS in a selected group of schools.

Dr Nigel Wilson from Auckland City Hospital will investigate rheumatic heart disease, which can require heart operations, and can lead to decreased life expectancy. Most rheumatic heart disease follows an attack of rheumatic fever. However, some children have episodes of undetected heart inflammation, leading to rheumatic heart disease, without being unwell in childhood.

Rheumatic heart disease can be detected with a 5-minute heart scan using portable ultrasound (echo). Penicillin prevents progression of heart problems but it is unproven whether echo-detected rheumatic heart disease is as serious as that following an episode of classical rheumatic fever. A programme of echo screening to detect rheumatic heart disease has already been undertaken in five regions. The planned research will re-examine the screened rheumatic heart disease children to confirm how serious echo-detected rheumatic heart disease becomes. The risk of rheumatic heart disease in families of rheumatic heart disease children will also be examined. Benefits and harms of echo screening will be determined to ascertain if this is an acceptable and safe public health tool.
The following list of successful applicants includes the named principal investigator only.

Professor Michael Baker
University of Otago
Identifying risk factors for rheumatic fever in New Zealand
36 months, $799,362
Telephone: (04) 385 5541 ext. 6802

Professor Julian Crane
University of Otago
Probiotic intervention to reduce streptococcal disease burden in NZ children
35 months, $790,319
Telephone: (04) 918 5258

Professor Diana Lennon
Auckland UniServices Ltd
Which school model for group A streptococci and acute rheumatic fever reduction?
36 months, $798,000
Telephone: (09) 373 7599 ext. 98188

Dr Nigel Wilson
Auckland DHB Charitable Trust
The significance of rheumatic heart disease detected by echocardiography
36 months, $800,000
Telephone: (09) 307 4949 ext. 23642