An outbreak of acute rheumatic fever in a remote Aboriginal community

Abstract

An outbreak of acute rheumatic fever in a remote Aboriginal community Natasha Egoroff,1,2,3, * Hilary Bloomfield,2,3 Wanamula Gondarra,2 Brando Yambalpal,2 Terrence Guyula,3 Demi Forward,2 Gemma Lyons,2 Emer O’Connor,2,3,5 Lou Sanderson,2 Michelle Dowden,6 Desley Williams,3 Jessica de Dassel,3 Pasqualina Coffey,3 Elizabeth Rrapa Dhurrkay,2 Veronica Gondarra,2 Deborah C. Holt,4 Vicki L. Krause,3 Bart J. Currie,4,5 Kalinda Griffiths,4,7,8 Karen Dempsey,2 Anna Glynn-Robinson1 1 National Centre for Epidemiology and Population Health, Australian National University, Australia 2 Miwatj Health Aboriginal Corporation, Australia 3 Centre for Disease Control, Northern Territory Health, Australia 4 Menzies School of Health Research, Charles Darwin University, Australia 5 Rheumatic Heart Disease Australia, Australia 6 One Disease, Australia 7 University of New South Wales, Australia 8 University of Melbourne, Australia Submitted: 30 January 2023; Revision requested: 8 July 2023; Accepted: 12 July 2023 Abstract Objectives: We describe the public health response to an outbreak of acute rheumatic fever (ARF) in a remote Aboriginal community. Methods: In August 2021, the Northern Territory Rheumatic Heart Disease Control Program identified an outbreak of acute rheumatic fever in a remote Aboriginal community. A public health response was developed using a modified acute poststreptococcal glomerulonephritis protocol and the National Acute Rheumatic Fever Guideline for Public Health Units. Results: 12 cases were diagnosed during the outbreak; six-times the average number of cases in the same period in the five years prior (n=1.8). Half (n=6) of the outbreak cases were classified as recurrent episodes with overdue secondary prophylaxis. Contact tracing and screening of 11 households identified 86 close contacts. Conclusions: This outbreak represented an increase in both first episodes and recurrences of acute rheumatic fever and highlights the critical need for strengthened delivery of acute rheumatic fever secondary prophylaxis, and for improvements to the social determinants of health in the region. Implications for Public Health: Outbreaks of acute rheumatic fever are rare despite continuing high rates of acute rheumatic fever experienced by remote Aboriginal communities. Nevertheless, there can be improvements in the current national public health guidance relating to acute rheumatic fever cluster and outbreak management. Key words: acute rhematic fever, outbreak, public health response, group A Streptococcus, notifiable disease, rhematic heart disease