February 2017 Rheumatic Fever Update
A new case of Acute Rheumatic Fever suggests a high group A streptococcal (GAS) burden in the communities where they live and learn.
This map shows the places across Auckland where children and young people (0-19 years) diagnosed with rheumatic fever lived and learnt last quarter (Oct-Dec 2017).
GPs and practice nurses working in these areas are asked to be vigilant for group A streptococcal (GAS) pharyngitis and acute rheumatic fever.
Sore Throat Treatment Recommendations (see algorithm below):
- Give antibiotics without swabbing to Māori and Pacific aged 0-19 years with a sore throat if you are concerned they may not return for a prescription.
- Otherwise - swab Māori and Pacific children 0-19 years and treat if they have a positive GAS throat swab result.
- First line treatment for GAS pharyngitis is Amoxycillin* given once a day for 10 days
Have a Low Threshold for Acute Rheumatic Fever
► Weight ≤30kg: 750 mg once daily for 10 days
► Weight >30kg: 1,000 mg once daily for 10 days
*Erythromycin can be used in patients with a penicillin allergy
If a Māori or Pacific child presents with a sore joint, abnormal movements, and/or a new heart murmur, have a low index of suspicion for acute rheumatic fever. Do a throat swab, ESR, CRP and streptococcal titres and refer to hospital if rheumatic fever is suspected.
(Click image for larger version)
January 2017 Rheumatic Fever Update
In the 1930’s a study in army barracks found that if beds were spaced further apart (~1m between people) and ventilation improved, then the rate of rheumatic fever dropped.* In the 1980’s a link was found between sleeping in a bed with another person and rheumatic fever.**
What is the sleeping situation for people with rheumatic fever?
A New Zealand Study in 2012 found that 49% of people with Acute Rheumatic Fever (ARF) shared a bed with at least one other person, compared with 19% in the comparison group.***
Proportion of people who share a bed with someone
1 in 8
people diagnosed with ARF in 2012 shared a bed with three or more people
Small houses with large or multiple families in them increase the chance that someone in the house will get a serious infectious illness from living in close quarters.
Here are some tips for keeping well in a busy and full household.
* Glover JA. Milroy lectures on the incidence of rheumatic diseases. Lancet. 1930; 499-505.
** Adanja BH et al. Socioeconomic factors in the etiology of rheumatic fever. J Hyg Epidemiol Microbiol 112 Immunol. 1988; 32: 329-355.
*** Oliver JR, et al. Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study. J Paediatr Child Health. 2017 Jan 4. [Epub ahead of print].
Travellers who arrived at Auckland International Airport on Air New Zealand flight NZ281 from Singapore at midnight on January 25 may have been exposed to measles, says the Auckland Regional Public Health Service (ARPHS).
The passengers closest to the six-year-old boy were seated in rows 34 to 49.
Medical Officer of Health Dr David Sinclair says the boy was infectious while on the flight.
“It could be another five days before symptoms appear in other passengers but if anyone seated in those rows knows they don’t have immunity to measles they can be vaccinated, and that could prevent the symptoms developing,” he says.
He says any passengers on that flight who start to feel unwell should telephone their doctor or call Healthline on 0800 611-116 for advice.
“If you feel unwell, please don’t visit your doctor. It is important to call first, because measles is highly infectious and people with measles can infect others in the waiting room,” Dr Sinclair says.
ARPHS is attempting to contact all exposed people, checking whether they are susceptible to measles infection, and offering advice which includes further immunisation, or possibly isolation to avoid spreading the disease.
Measles is a serious illness. One in 10 people with measles need hospital treatment and the most serious cases can result in deafness or swelling of the brain. Dr Sinclair says measles is infectious before the rash appears and is one of the most infectious airborne diseases. Other passengers on the flight could also be infected.
“It is very easily transmitted from one person to another, possibly just from walking past the passenger with measles, or while sitting near them in the airport gate lounge.”
People most at risk of contracting the disease are those who have not had the measles, mumps, rubella (MMR) vaccine, or who have just had one dose of the vaccine. Anyone born before 1969 is likely to be immune to the disease without having had the vaccine.
“The only way to protect from measles and the best way to avoid its complications is to be fully vaccinated. My plea would be for parents and families to check that their children’s immunisations are up-to-date,” Dr Sinclair says.
How to protect you and your family against measles:
- Make sure your children and family are fully immunised with two doses of the vaccine. Immunisation is the best protection against many diseases and complications.
- Measles can’t be treated once you get it. The only way to prevent the disease is through immunisation.
Dr Sinclair, Medical Officer of Health for the Auckland Regional Public Health Service, says the time delay from being exposed to measles to developing symptoms is usually 8 -14 days, but can be up to 21 days. The typical symptoms of measles are:
- The first symptoms are a fever, and one or more of a runny nose, cough and sore red eyes
- Then after a few days a red blotchy rash comes on and lasts up to one week. The rash usually starts on the face and spreads to the rest of the body
- Children and adults with measles are often very sick.
“If you were on that flight and you detect any of those symptoms, please call your doctor, or call Healthline toll free at any hour of the day or night on 0800 611-116,” says Dr Sinclair.
People should not go directly to a doctor’s office or to an emergency department, because if they do have measles they might infect other people.
Dr Sinclair says: “Measles is now rare in New Zealand, thanks to immunisation. We had two big outbreaks in 2011 and 2014, each of which was started by people who were infected overseas. People tend to underestimate measles. The reality is it can be a nasty disease.”
| ADDITIONAL INFORMATION
|Call Healthline 0800 611 116 for Free Health Advice
Healthline is a free 24-Hour Telephone Health Information Service for all families. The service is staffed by registered nurses who will assess your health needs, and give information and advice to help you decide on the best level of care.
If you think you or someone in your care has measles
Prompt identification can help limit the spread of measles to others. If you or anyone in your care displays common symptoms such as a runny nose, cough, sore eyes and fever, followed by a raised red rash that starts on the face and moves to cover the rest of the body, seek immediate medical help – contact Healthline on 0800 611 116 or your local doctor.
Phone before visiting a doctor to minimise the spread of infection to others in the waiting room.
It is also important that if you suspect you may have measles, or you have had contact with someone suspected to have measles and you are not immune, that you remain in isolation to limit the spread of the disease.
How do I know if I am immune?
People born before 1969 or who have received two doses of the measles, mumps and rubella vaccine (MMR) or who have had measles in the past are considered to be immune.
Immunisation is the only effective way to protect against the disease. If you or any children in your care are not up to date with immunisations, then contact your doctor or practice nurse and arrange to catch up as soon as possible. MMR is given in two doses, normally at 15 months and 4 years of age giving over 95% protection. However, it’s never too late to get immunised.
Healthline has access to Language Line Monday to Friday, 9am to 6pm. When you call Healthline during these hours, the nurse can usually arrange for an interpreter. Outside these hours Healthline uses other interpreter services as far as possible. It is not always possible to locate an interpreter in a particular language at short notice.
For more information call the Immunisation Advisory Centre free on 0800 IMMUNE (0800 466 863) or visit www.immune.org.nz.
December 2016 Rheumatic Fever Update
Household crowding has been associated with the risk of getting rheumatic fever in a number of studies. It is thought that the more people there are in a house, the more likely it is that a child will come into contact with the group A streptococcal (GAS) bacteria that triggers rheumatic fever.
So how bad is it really?
A study in 2012 found that household crowding is much more common for people with acute rheumatic fever
compared to the NZ Census, both overall and for Māori and Pacific people.* In particular extreme crowding (2 bedroom deficit) in cases with ARF is 34.5% vs 3.5% in the general population.
Household Crowding for People with Acute Rheumatic Fever
2012 NZ Cohort Study
How common is household crowding in Auckland Kids?
At the 2013 Census, 61,707
Auckland children aged 0-14 years old lived in a crowded household.**
That is 1 out of every 5 Auckland kids.
* Oliver JR, et al. Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study. J Paediatr Child Health. 2017 Jan 4. [Epub ahead of print].
** Simpson J, Oben G, Craig E, Adams J, Wicken A, Duncanson M, and Reddington A. The Determinants of Health for Children and Young People in New Zealand. Dunedin, NZ Child & Youth Epidemiology Service, University of Otago; 2016.
A bar owner has been convicted for breaking smoking laws in a landmark case which may encourage others to make their establishments completely smoke-free.
Auckland public health manager Dean Adam says the owner was given ample opportunity to modify his premise to meet the new guidelines.
“He refused to make changes despite numerous discussions with officers from Auckland Regional Public Health Service (ARPHS),” he says.
Public health authorities urge bar and restaurant owners to check the new Ministry of Health guidelines for non-smoking areas. Even if their venue has complied in the past, they may not meet the new criteria.
Mr Adam from ARPHS says owners may want to consider a completely smoke free environment which is already in place at many popular dining establishments in Auckland.
Hospitality entrepreneur Scott Brown owns several of Auckland’s most successful cafes, bistros and restaurants under the Hip Group banner, including Takapuna Beach Café, Ortolana, Amano and St Heliers Bar & Bistro. He says diners don’t want second-hand smoke with their food.
“We have a total smoking ban at our 16 eateries because we want to give our customers the ultimate dining experience. Outdoor diners and staff don’t enjoy smoke blowing in their faces during a meal.”
“Nobody has walked out because of our smoke-free policy. In fact we have more customers come back because of it,” says Scott Brown.
Dean Adam from ARPHS says breathing in other people’s tobacco smoke, or second-hand smoke puts you more at risk of heart disease, lung cancer, stroke and nasal cancer.
Mr Adam encourages Auckland diners to chat with owners of their favourite local establishments about the benefits of a completely smoke free environment. The Hip Group is testament that the smoke free is trend is catching on in hospitality and Auckland research is clear that this is something the public supports.
The bar owner was sentenced on January 20 in the North Shore District Court and fined $2700 across four charges plus $850 in solicitor’s costs and $130 court costs.
To find out more about the new Ministry of Health Guidelines for smoke free areas click here
Below is the full video interview with Scott Brown on the benefits of a smoke-free policy.
This notice was last updated on 10 January 2017
There is a worldwide shortage of BCG vaccine affecting many countries, including New Zealand.
As a result there is no BCG vaccine available in New Zealand until further notice.
Until vaccine becomes available, there will be no BCG vaccination services in the greater Auckland region.
We ask that parents and caregivers do not call ARPHS, as we have no further information about BCG vaccine and we are not booking any BCG appointments.
This page will be updated if BCG vaccine becomes available again, but this is very unlikely to happen before the end of 2017.
For more information see the Ministry of Health website.
If you have a media enquiry, please call the ARPHS Media line on 021 243 2421.
All requests for interviews, photographs or filming must be made through this channel.