Dr Ken Chau is a basic physician trainee working at the Cairns Base Hospital. He graduated from Queens' University Belfast and completed his foundation training in UK before continuing his medical training in Australia. He is a keen researcher and is currently working on Acute Rheumatic Fever and Rheumatic Heart Disease, identifying gaps and improving healthcare provision particularly among the people in Far North Queensland.
Increasing Incidence of Acute Rheumatic Fever in
Far North Queensland 1997-2017
The incidence of acute rheumatic fever (ARF) remains stubbornly elevated in Australian Indigenous communities. This study aimed to define the temporospatial epidemiology of ARF in Far North Queensland (FNQ) to inform prevention strategies.
Individuals diagnosed with ARF in FNQ between 1997 and 2017 were identified using the Queensland RHD register and public health system data.
ARF was diagnosed in 566 individuals; 320 (57%) were female, 541 (96%) identified as Indigenous Australians, and 264 (46%) lived in metropolitan areas. The median (interquartile range (IQR) age) at the initial ARF diagnosis was 12 (9-17) years; 173 (30%) were aged ≥16 years at the time of initial diagnosis. The incidence of ARF increased from 8.4/100,000/year in 1997 to 10.0/100,000/year in 2017 (p=0.02). At the end of the study period the incidence in Indigenous Australians was 55.3/100,000/year versus 0.4/100,000/year in non-Indigenous Australians (p<0.001); the incidence in rural and remote locations was 64/100,000/year compared with 4/100,000/year in metropolitan areas (p<0.001). Recurrent ARF occurred in 171 (30%), while 259 (46%) developed echocardiographically-confirmed RHD during the study period, 26 (10%) of whom required valve surgery.
Appropriate secondary prophylaxis was prescribed in 549/566 (97%). The median (IQR) adherence was 45% (28-60%). Median (IQR) adherence was similar in Indigenous (45% (28-60%) and non-Indigenous individuals (46% (23-62%), p=0.92) and in metropolitan (42 (23-56%) and rural and remote settings (47% (31-62%), p=0.60). Median (IQR) adherence improved from 31% (8-46%) in 2007 to 54% (38-77%) in 2017, p=0.01), but only 8 (1.5%) received >80% of scheduled secondary prophylaxis doses in >80% of years it was prescribed.
Indigenous Australians in rural and remote areas continue to bear a disproportionate burden of ARF. Adherence to secondary prophylaxis is improving but remains suboptimal. Novel strategies are necessary to improve delivery of secondary prophylaxis and reduce the burden of this preventable disease.