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Rheumatic Fever Research Papers

1. WHO Technical Report Series; 923. Geneva: World Health Organization; 2004. WHO Expert Consultation on Rheumatic Fever and Rheumatic Heart Disease (2001: Geneva Switzerland). Rheumatic fever and rheumatic heart disease: Report of a WHO Expert Consultation, Geneva, 29 October - 1 November 2001.

2. Rimoin AW, Hamza HS, Vince A, Kumar R, Walker CF, Chitale RA, et al. Evaluation of the WHO clinical decision rule for streptococcal pharyngitis. Arch Dis Child. 2005;90:1066–70.[PMC free article][PubMed]

3. Carapetis JR, Steer AC, Mulholland EK. The current evidence for the burden of group A streptococcal diseases (WHO/FCH/CAH/05.07) Geneva: World Health Organization; 2004.

4. Carapetis JR. Group A streptococcal vaccine development: Current status and issues of relevance to less developed countries (WHO/FCH/CAH/05.09 and WHO/IVB/05.14) Geneva: World Health Organization; 2004.

5. Carapetis JR. A review of the technical basis for the current WHO approach to the control of conditions associated with group A streptococcal infections (WHO/FCH/CAH/05.08) Geneva: World Health Organization; 2004.

6. Mayosi B, Robertson K, Volmink J, Adebo W, Akinyore K, Amoah A, et al. The Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease in Africa. S Afr Med J. 2006;96:246.[PubMed]

7. Colquhoun SM, Carapetis JR, Kado JH, Steer AC. Rheumatic heart disease and its control in the Pacific. Expert Rev Cardiovasc Ther. 2009;7:1517–24.[PubMed]

8. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia: An evidence-based review. Melbourne: National Heart Foundation of Australia; 2006.

9. Kumar R, Thakur JS, Aggarwal A, Ganguly NK. Compliance of secondary prophylaxis for controlling rheumatic fever and rheumatic heart disease in a rural area of northern India. Indian Heart J. 1997;49:282–8.[PubMed]

10. Bach JF, Chalons S, Forier E, Elana G, Jouanelle J, Kayemba S, et al. 10-year educational programme aimed at rheumatic fever in two French Caribbean islands. Lancet. 1996;347:644–8.[PubMed]

11. Wilson N. Rheumatic heart disease in indigenous populations--New Zealand experience. Heart Lung Circ. 2010;19:282–8.[PubMed]

12. Tibazarwa KB, Volmink JA, Mayosi BM. Incidence of acute rheumatic fever in the world: A systematic review of population-based studies. Heart. 2008;94:1534–40.[PubMed]

13. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5:685–94.[PubMed]

14. Mincham CM, Mak DB, Plant AJ. The quality of management of rheumatic fever/heart disease in the Kimberly. Aust N Z J Public Health. 2002;26:417–20.[PubMed]

15. Harrington Z, Thomas DP, Currie BJ, Bulkanhawuy J. Challenging perceptions of non-compliance with rheumatic fever prophylaxis in a remote Aboriginal community (mm ref 2769) Med J Aust. 2006;184:514–7.[PubMed]

16. Gardner KL, Dowden M, Togni S, Bailie R. Understanding uptake of continuous quality improvement in Indigenous primary health care: Lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project. Implement Sci. 2010;5:21.[PMC free article][PubMed]

17. Zaher S, Kassem A, Abou-Shleib H, El Khouly A, Madkour A, Kaplan E. Differences in serum penicillin concentrations following intramuscular injection of benzathine penicillin G (BPG) from different manufacturers. J Pharm Med. 1992;2:17–23.

18. Stollerman GH, Rusoff JH. Prophylaxis against group A streptococcal infections in rheumatic fever patients; Use of new repository penicillin preparation. J Am Med Assoc. 1952;150:1571–5.[PubMed]

19. Kassem AS, Zaher SR, Abou Shleib H, el-Kholy AG, Madkour AA, Kaplan EL. Rheumatic fever prophylaxis using benzathine penicillin G (BPG): Two- Week versus four-week regimens: Comparison of two brands of BPG. Pediatrics. 1996;97:992–5.[PubMed]

20. Kaplan EL, Berrios X, Speth J, Siefferman T, Guzman B, Quesny F. Pharmacokinetics of benzathine penicillin G: Serum levels during the 28 days after intramuscular injection of 1,200,000 units. J Pediatr. 1989;115:146–50.[PubMed]

21. Bass JW, Longfield JN, Jones RG, Hartmann RM. Serum levels of penicillin in basic trainees in the U.S. Army who received intramuscular penicillin G benzathine. Clin Infect Dis. 1996;22:727–8.[PubMed]

22. Ngo HT, Arnold-Reed DE, Hansson RC, Tait RJ, Hulse GK. Blood naltrexone levels over time following naltrexone implant. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:23–8.[PubMed]

23. Nordet P, Lopez R, Duenas A, Sarmiento L. Prevention and control of rheumatic fever and rheumatic heart disease: The Cuban experience (1986-1996-2002) Cardiovasc J Afr. 2008;19:135–40.[PMC free article][PubMed]

24. Michaud C, Rammohan R, Narula J. Cost-effectiveness analysis of intervention strategies for reduction of the burden of rheumatic heart disease. In: Narula J, Virmani R, Reddy KS, Tandon R, editors. Rheumatic fever. Washington DC: American Registry of Pathology; 1999. pp. 485–97.

25. Michaud C, Gutierrez J, Cruz C, Pearson T. The World Bank health sector priorities review: Rheumatic heart disease. Washington, D C: World Bank; 1991. pp. 1–31.

26. Carapetis JR, Powers JR, Currie BJ. Outcomes of cardiac valve replacement for rheumatic heart disease in Aboriginal Australians. Asia Pac Heart J. 2000;8:138–47.

27. Levine HJ, Pauker SG, Salzman EW. Antithrombotic therapy in valvular heart disease. Chest. 1986;89:36S–45.[PubMed]

28. Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Miller N, et al. Antithrombotic therapy in valvular heart disease--native and prosthetic: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:457S–82S.[PubMed]

29. Sanyal SK, Thapar MK, Ahmed SH, Hooja V, Tewari P. The initial attack of acute rheumatic fever during childhood in North India; A prospective study of the clinical profile. Circulation. 1974;49:7–12.[PubMed]

30. Feinstein AR, Wood HF, Spagnuolo M, Taranta A, Jonas S, Kleinberg E, et al. Rheumatic Fever in Children and Adolescents.A Long-Term Epidemiologic Study of Subsequent Prophylaxis, Streptococcal Infections, and Clinical Sequelae. Vii. Cardiac Changes and Sequelae. Ann Intern Med. 1964;60:87–123.[PubMed]

31. Paar JA, Berrios NM, Rose JD, Cáceres M, Peña R, Pérez W, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol. 2010;105:1809–14.[PMC free article][PubMed]

32. Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med. 2007;357:470–6.[PubMed]

33. Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, Wilkinson L, Penny DJ, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med. 2008;5:411–7.[PubMed]

34. Cherian T, Mulholland EK, Carlin JB, Ostensen H, Amin R, de Campo M, et al. Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ. 2005;83:353–9.[PMC free article][PubMed]

35. Jones TD. Diagnosis of rheumatic fever. JAMA. 1944;126:481–4.

36. Diagnosis, management and secondary prevention. Auckland: Heart Foundation of New Zealand; 2006. Heart Foundation of New Zealand and Cardiac Society of Australia and New Zealand. New Zealand Guidelines for Rheumatic Fever. 1.

37. Mataika R, Carapetis JR, Kado J, Steer AC. Acute rheumatic fever: An important differential diagnosis of septic arthritis. J Trop Pediatr. 2008;54:205–7.[PubMed]

38. Cilliers AM, Manyemba J, Saloojee H. Anti-inflammatory treatment for carditis in acute rheumatic fever. Cochrane Database Syst Rev. 2003:CD003176.[PubMed]

39. Towers RJ, Bolm M, Currie BJ, Chhatwal GS, Fagan PK. Autoantigens identified by screening a human heart cDNA library with acute rheumatic fever sera. Ann N Y Acad Sci. 2009;1173:83–91.[PubMed]

40. Engel ME, Sr, Vogel J Adeyemo AA, Mayosi BM. Genetic contribution to rheumatic fever: A systematic review and meta-analysis of twin studies.[Presented at the 8th National Congress of the South African Heart Association, Sun City, 22-25 November 2007] S Afr Med J. 2007;97:1094.

41. Bryant PA, Robins-Browne R, Carapetis JR, Curtis N. Some of the people, some of the time: Susceptibility to acute rheumatic fever. Circulation. 2009;119:742–53.[PubMed]

42. Karthikeyan G, Mayosi BM. Is primary prevention of rheumatic fever the missing link in the control of rheumatic heart disease in Africa? Circulation. 2009;120:709–13.[PubMed]

43. Carapetis J, Steer A. Prevention of rheumatic fever. Pediatr Infect Dis J. 2010;29:91–2. author reply 2. [PubMed]

44. Carapetis JR. Letter by Carapetis regarding article, “Is primary prevention of rheumatic fever the missing link in the control of rheumatic heart disease in Africa?” Circulation. 2010;121:e384. author reply e5. [PubMed]

45. Lennon D, Stewart J, Farrell E, Palmer A, Mason H. School-based prevention of acute rheumatic fever: A group randomized trial in New Zealand. Pediatr Infect Dis J. 2009;28:787–94.[PubMed]

46. Lennon D, Kerdemelidis M, Arroll B. Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic fever. Pediatr Infect Dis J. 2009;28:e259–64.[PubMed]

47. McDonald M, Currie BJ, Carapetis JR. Acute rheumatic fever: A chink in the chain that links the heart to the throat? Lancet Infect Dis. 2004;4:240–5.[PubMed]

48. Lawrence G, Leafasia J, Sheridan J, Hills S, Wate J, Wate C, et al. Control of scabies, skin sores and haematuria in children in the Solomon Islands: Another role for ivermectin. Bull World Health Organ. 2005;83:34–42.[PMC free article][PubMed]

Australia has one of the highest rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world. Indigenous people are up to eight times more likely than other groups to be hospitalised and nearly 20 times as likely to die from this disease.

ARF is caused by an immunological response to group A streptococcal (GAS) infection and can lead to permanent heart damage, a condition known as RHD. Globally, RHD is the most common cause of cardiac death in children and adults aged under 40 years. However, through simple and cost effective strategies, almost all cases of RHD and associated deaths are preventable.

There are at least 15.6 million people with RHD worldwide and, annually, over 230 000 people die from the disease. There are another 1.9 million people with a history of ARF and 470 000 new cases are diagnosed every year. These figures, however, are likely to be an underestimate of the true burden of the disease.

Some of the highest rates of ARF and RHD in the world are found in Indigenous Australians (particularly across central and northern Australia), Maoris and Pacific Island populations. The Pacific region, including Fiji, has the highest reported prevalence of RHD. The prevalence of RHD is also high in sub-Saharan Africa, Latin America, the Indian subcontinent, the Middle East and Northern Africa. Menzies' researchers work with high risk populations in Australia and the Pacific Region.

Incidence of ARF and RHD falls dramatically with improved living conditions and increased hygiene standards, along with better access to appropriate health services and penicillin-based medications (known as secondary prophylaxis).

Menzies’ research mainly targets primary and secondary prevention of ARF and RHD. This means stopping people from getting the disease in the first place, but if they do get it, treating them to keep them healthy.

Our research focus:
  • To test whether a model of care designed to optimise health systems and community resources improves adherence to secondary prophylaxis for RHD
  • To understand why ARF converts to RHD in some people. Many Indigenous Australians will get group A streptococcus infections but only some will develop RHD. Launched in 2012, RHD Genetics is a collaborative study into the role genetics plays in the disease’s presence and progression
  • To provide an evidence base to improve clinical care and outcomes for women with RHD in pregnancy and for their babies
  • To find markers in the blood that can be used to rapidly and accurately diagnose ARF so people can get the treatment they need as soon as possible
  • To establish the prevalence of RHD in high-risk Indigenous Australian children and to compare the findings with children at low risk for RHD and to determine the accuracy of cardiac auscultation in detecting echocardiographically- confirmed RHD
  • To provide direct program support and conduct research under the World Heart Federation RHD Pacific and International Program, including:
    • RHD genetics study in Fiji and New Caledonia.
    • A BPG adherence study in Fiji
    • A cost analysis of burden of RHD in New Caledonia and Fiji
    • An evaluation of the ASAP RHD program in South Africa and Ethiopia
    • Development of an RHD train the trainer module for international and regional Pacific use
    • Collaboration and sharing of resources with many other countries in Asia, Africa and South America.
Our research impact:
  • RHDAustralia was established in 2009 as the National Coordination Unit to support control of rheumatic heart disease in Australia and is based at Menzies School of Health Research, Darwin. RHDAustralia partners with Baker IDI, James Cook University, Telethon Kids Institute and South Australian Health and Medical Research Institute. RHDAustralia is funded under the Department of Health's Rheumatic Fever Strategy.
  • In partnership with the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, RHDAustralia led a review of the national guidelines (published in 2006) based on new evidence.
  • RHDAustralia developed ipad, iPhone and Android applications for clinicians based on the latest diagnosis and management guidelines.
  • RHDAustralia created a series of five online interactive modules to provide the health workforce with an introductory-level understanding of best practice approaches to the prevention, diagnosis and management of ARF and RHD.
  • Developed 15 specialised modules for clinicians, by clinicians, on rheumatic heart disease topics such as pregnancy, medical management of mitral valve disease, medical management of aortic valve disease and dental care.

RHDAustralia has developed a suite of educational resources, based on the Australian guideline for the prevention, diagnosis and management of ARF and RHD (2nd edition), for health professionals and communities. These can be accessed on the RHDAustralia website, along with a resource database of Australian ARF and RHD educational tools.

For the latest articles click here to be taken to the RHDAustralia news website.

  1. Sharing a Heartbeat: Rheumatic heart disease movie released in Darwin


    A push for more awareness around the effects of rheumatic heart disease on pregnancy has led to a film developed, written, and directed by Australian Indigenous women.

  2. Rheumatic heart disease program in East Timor 'saving lives' with 'simple' penicillin injections


    Australian doctors are working with East Timorese health workers to screen and treat children and young people with the illness, using methods similar to those used in Australia.

  3. Rheumatic heart disease: Preventable illness in Indigenous communities 'a national failure', AMA says


    The Australian Medical Association has singled out a preventable disease caused by impoverished living conditions and untreated infections as Australia's "national failure".

  4. Launch of new e-learning modules to target world�s highest rate of rheumatic heart disease


    RHDAustralia will launch 15 new �clinician e-learning modules� at a seminar in Darwin as part of Australia�s Rheumatic Fever Strategy to tackle the world�s highest recorded rate of acute rheumatic fever and rheumatic heart disease.

  5. Seminar to reduce world�s highest rate of rheumatic heart disease in children


    RHDAustralia will host a free seminar in Cairns tonight as part of Australia�s Rheumatic Fever Strategy to reduce the world�s highest recorded rate of acute rheumatic fever.

  6. Forum to forge path to end rheumatic heart disease


    200 international leading experts and advocates for rheumatic heart disease will converge at the 3rd Global Rheumatic Heart Disease Forum in Melbourne next week.

  7. Call to arms to save children from rheumatic heart disease


    A leading paediatric cardiologist has emphasised the need to prevent RHD in Indigenous children to avoid premature death, cardiac surgery and stroke to allow them to live a fulfilling life.

  8. Beating rheumatic heart disease: Experts converge in Darwin


    Experts from around the country will meet in Darwin today at the RHD Australia Conference 2013: Practice and Culture to strengthen Australia�s fight to prevent rheumatic heart disease.

  9. Preventable disease leaves 13 year old with mechanical heart failure


    RHD Australia will mark World Heart Day on 29 September by reminding people that rheumatic heart disease is preventable. Diagnosed at the age of seven, Carlisa Willika from the Werenbun community north of Katherine in the Northern Territory has lived with rheumatic heart disease for five years.

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