Notification of Rheumatic Heart Disease and Acute Rhematic Fever

Key messages

• On 31 July 2023, acute rheumatic fever (ARF) and rheumatic heart disease (RHD) will become routine notifiable conditions in Victoria.
• ARF and RHD can occur as a complication of infection with the Group A Streptococcus (GAS) bacterium.
• Both ARF and RHD are medical conditions caused by GAS but are not themselves infectious diseases.
• Medical practitioners who reasonably believe that a patient has, or may have, ARF or RHD must notify the Victorian Department of Health within five business days.
• ARF and RHD disproportionately impact certain Victorian populations including Aboriginal and Torres Strait Islander people and Pacific Islander people, leading to chronic complications and health disparities.

What is the issue?

The Public Health and Wellbeing Act 2008 requires that prescribed conditions and micro-organisms are notified to the Department of Health. This law exists to monitor and control the occurrence of infectious diseases and other specific conditions to protect the community from further illness.

Making ARF and RHD notifiable conditions enables the collection of more comprehensive, accurate and informative data to support the public health response to these conditions.

ARF is primarily (but not exclusively) a disease of childhood that occurs as a complication following an infection with the Group A Streptococcus bacterium (GAS), also known as Streptococcus pyogenes). If untreated, GAS pharyngitis (‘strep throat’) can lead to ARF, which is typically manifested by inflammation of the joints, heart, skin, and central nervous system.

People with ARF are recommended to start regular antibiotic treatment (‘secondary prophylaxis’) to prevent further GAS infections and minimise the risk of disease progression.

RHD develops after one or more bouts (episodes) of ARF during a person’s childhood or adolescence. However, RHD can also develop following subclinical or unrecognised ARF.

Patients with RHD have chronic valvular heart disease. Early in the disease, RHD may not cause any symptoms. Later, patients may have a range of symptoms, culminating in heart failure. People with RHD often need cardiac surgery to replace or repair their heart valves. Worsening of symptoms and both cardiac and obstetric complications can occur during pregnancy.

Who is at risk?

Rates of ARF are highest in those aged between 5 and 14 years.

ARF and RHD are preventable conditions disproportionately affecting certain priority populations in Victoria, particularly Aboriginal and Torres Strait Islander people and Pacific Islander people. Children and adolescents from these communities are significantly overrepresented as patients. Immigrants from developing countries, including refugees and asylum seekers, are also at increased risk. Having a personal or family history of ARF or RHD also increases a person’s risk of developing these conditions.

Other risk factors for ARF and RHD include living in overcrowded conditions and having limited access to bathing and facilities to wash clothes and bedding.

Diagnosis

Diagnosis of ARF is based on clinical features, pre-existing risk, and laboratory evidence of a preceding GAS infection, as described in the Revised Jones Criteria.

Diagnosis of RHD is based on echocardiographic findings and interpretation by a cardiologist.

Detailed information on diagnosis and management of these conditions can be found in The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022).

Recommendations

For medical practitioners

• Medical practitioners who reasonably believe that a patient has, or may have, ARF or RHD must notify the Victorian Department of Health within five business days.
• All cases of RHD must be notified, including both newly diagnosed and pre-existing disease.
• Medical practitioners can notify using the Communicable Diseases online notification tool or by downloading and completing the ARF/RHD notification form and returning it by post or fax.
• Further details about the notification process and the downloadable notification form can be found at the Notifiable infectious diseases, conditions and micro-organisms page.
• Further clinical guidance information is available inThe 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022).
• Visit the Department’s notification procedures for infectious disease page for more information on notification and Public Health and Wellbeing legislation (Public Health and Wellbeing Act 2008 and Public Health and Wellbeing Regulations 2019).