Rheumatic Fever Prevention Programme commonly asked questions

Rheumatic fever is a deadly disease with 92% of all cases affecting Pacific and Maori children. It starts with a sore throat and can lead to heart surgery, and is more prevalent in the colder winter months. Rheumatic fever is a painful illness that is preventable, so take note of the key prevention message: Get your child’s sore throat checked now.

 

Image credit: www.hpa.org.nzHere are some commonly asked questions about rheumatic fever that can help you be better prepared.
 

Rheumatic fever 

  1. What is rheumatic fever?

    Rheumatic fever can happen after a sore throat called strep throat.

    Most strep throats get better and don't lead to rheumatic fever. However, in a small number of people – mostly children and young people aged 4-19 years – an untreated strep throat develops into rheumatic fever, where their heart, joints, brain and skin become inflamed and swollen.

    While the symptoms of rheumatic fever may disappear on their own, the inflammation can damage the heart. This is rheumatic heart disease.
     
  2. What are the symptoms of rheumatic fever?

    Rheumatic fever symptoms include:

    • sore and swollen joints (knees, elbows, hips). Joints may feel hot and different joints may be sore on different days

    • a fever that lasts a few days

    • rash over the elbows, wrists, knees, ankles, and spine

    • small lumps under the skin

    • jerky movements of hands, feet, tongue and face

    If your child has these symptoms take them to the doctor or nurse straight away to get them checked.

    They may also have:

    • stomach pains

    • extreme tiredness

    • weight loss

    It is important to note that a sore throat is not an early symptom of rheumatic fever.

     
  3. When are we likely to notice rheumatic fever symptoms?

    The symptoms of rheumatic fever will usually start 1–5 weeks after your child has had a strep throat infection that hasn’t been treated with antibiotics.
     
  4. Will these symptoms of rheumatic fever go away?

    Most of these symptoms, such as sore or swollen joints (knees, elbows, ankles and wrists), a skin rash, a fever, stomach pain and jerky movements, will go away in time.

    However, the inflammation caused by one rheumatic fever attack could develop into rheumatic heart disease, where there is scarring of the heart valves and your child may need heart surgery.
     
  5. Who is most likely to get rheumatic fever in New Zealand?

    In New Zealand, Maori and Pacific children and young people aged 4-19 years – particularly those who live in crowded homes and who have a family history of rheumatic fever – are more likely to get strep sore throats and therefore, rheumatic fever. Most cases of rheumatic fever are in our Maori and Pacific communities in parts of the North Island
     
  6. Are Maori and Pacific people genetically susceptible to rheumatic fever?

    No. While statistics show that Maori and Pacific people are more likely to be hospitalised for rheumatic fever, this is not because of a genetic susceptibility to do with ethnicity.

    Our Maori and Pacific people are more likely to get rheumatic fever because we have a more youthful population (and are therefore more likely to have strep throat infections).

    It's possible that other things likely to contribute to the higher rates of rheumatic fever among Maori and Pacific people are a combination of crowded homes (which mean that the strep germ is more likely to spread) and poor access to primary care (which means that strep sore throats are not treated).
     
  7. Are there any illnesses that might make you more susceptible to rheumatic fever?

    No

  8. Can you catch rheumatic fever?

    No, you cannot catch rheumatic fever from someone who has been diagnosed with it. But you can catch the strep throat germs that cause rheumatic fever. That’s why it’s important to treat strep throat infections as soon as possible with antibiotics.

  9. Which areas of the North Island have the most cases of rheumatic fever, so are most at risk?

    Northland, Auckland city, Waikato, Bay of Plenty, East Coast/Gisborne, Rotorua/Taupo/Turangi, Hawke’s Bay, Hutt Valley and Porirua.
     
  10. Why don’t adults tend to get rheumatic fever?

    Adults (over 35 years old) are not as susceptible as children and young people to rheumatic fever because they are less likely to get strep throat infections. 
     
  11. What happens if a child is diagnosed with rheumatic fever?

    Rheumatic fever is difficult to diagnose as there is no diagnostic laboratory test. Children or young people suspected to have rheumatic fever should be admitted to hospital for a thorough assessment, and a range of investigations done to confirm the diagnosis.

    The child will usually need to stay in hospital for some weeks, depending on how sick they are. They will have regular examinations and blood tests to help diagnose rheumatic fever. 
     
  12. What does a child diagnosed with rheumatic fever need to help recovery?

    A child with rheumatic fever will need a lot of bed rest and time off school. They’ll need to stay in hospital for some weeks – depending on how sick they are. In hospital, they will have examinations and blood tests to check their condition.

    How long they need to recover depends on how unwell the child is and whether their heart is affected by rheumatic fever.

    Depending on how unwell the child is, their doctor may give them anti-inflammatories to help reduce the swelling in the heart muscle and help the pain in their joints.

    Children and young people with rheumatic fever will also need to have ongoing penicillin injections every month for at least 10 years - to prevent another attack which may damage their heart.

    Rheumatic fever can affect a child’s life. Because they will have less energy, it may be more difficult for them to play sport or do other activities.

  13. What care will a child with rheumatic fever need at home?

    The child will still need to take it easy when they go home. They will need to have ongoing penicillin injections to prevent another attack. Another antibiotic, such as erythromycin, can be given to people who are allergic to penicillin.

    It is very important that your child does not get rheumatic fever again. Another attack could cause long-term damage to the heart and heart valves.
     
  14. How can I stop a child having another attack of rheumatic fever?

    The best way to stop a child having another attack of rheumatic fever is to make sure they have regular penicillin injections - on time.
    Penicillin injections:

    • must be given every 28 days (sometimes every 21 days)

    • are given in the child's thigh or bottom

    • can be painful

    • are given by your community nurse, district nurse or public health nurse
     
  15. How long will a child with rheumatic fever need to have penicillin injections?

    The child will need to have injections for 10 years, or until they are 21 years old, whichever is longer. If the child has damage to their heart valve they may need injections until they are 30 years old.

    This may seem like a long time .But if the child doesn't have these injections they could have another rheumatic fever attack which increases the risk of heart valve damage.

    Your doctor will tell you when it is safe for the child to stop having the penicillin injections.
     
  16. What if my child misses or forgets an injection?

    It is very important that your child does not miss an injection. If they do, then you must arrange for them to get the next injection as soon as possible.

    Remember to tell your doctor or nurse if your child is going overseas, on holiday, away for a while, or you are moving house.

    They can then arrange ongoing treatment for your child.

    Your child should never stop penicillin treatment without discussing this first with your doctor.

  17. Will my child diagnosed with rheumatic fever be able to lead a normal life?

    With proper care and regular penicillin injections, most children with rheumatic fever lead a normal life.

    The important thing is to make sure your child never has another attack of rheumatic fever. The only way you can do this is to make sure they have their regular penicillin injections.
     
  18. Do other health professionals need to know if my child has rheumatic fever?

    Yes. It’s important that you tell any oral health professional (dentist, dental nurse, hygienist or therapist) or other health carer that your child has rheumatic fever.

    Your child will need antibiotics before most dental or surgical procedures to help stop them getting an infection on their heart valves. This is called infective endocarditis. The germs that cause infective endocarditis tend to come from the mouth and then enter the bloodstream through injuries to the skin, lining of the mouth, or gums (including through dental and medical procedures).

    You need to help your child to look after their teeth and avoid any infection.

    • Make sure your child brushes their teeth twice a day with regular strength fluoride toothpaste – in the morning and before going to bed at night

    • A diet low in sugar is important to prevent tooth decay

    • Have dental checks every six months

Strep throat infections

  1. When should I get my child’s sore throat checked?

    If you live in any of the high risk areas -- Northland, Auckland city, Waikato, Bay of Plenty, East Coast/Gisborne, Rotorua/Taupo/Turangi, Hawke’s Bay, Hutt Valley or Porirua -- and your child is Maori or Pacific aged 4-19 years complaining of a sore throat, you should get it checked by a doctor or nurse as soon as possible.

    If it turns out that your child has strep throat they will be given antibiotics. Make sure they take the antibiotics for the full 10 days, even if they feel better. A simple course of antibiotics can prevent the strep throat turning into rheumatic fever.
     
  2. What is strep throat?

    A 'strep throat' is a throat infection caused by the Group A Streptococcus (GAS) germ.

    This strep throat germ is highly infectious and can be in droplets from saliva or mucus of an infected person. The strep throat germs are spread when the infected person coughs or sneezes.

    A strep throat infection can lead to rheumatic fever, even if it's the first time or a one-off. The risk of getting rheumatic fever gets higher when someone suffers from repeated, untreated strep throat infections.
     
  3. What should I be aware of if my child says they have a sore throat?

    A sore throat is pain or discomfort in the throat, making it swollen.

    Your child may find it hard to swallow, eat or drink because of the pain in their throat.

    Sometimes, especially for young children, it is hard for them to explain what they're feeling.

    You may need to explain to your child what a sore throat feels like and watch to see if they have problems swallowing, eating and drinking.

    If you look in your child's mouth and see redness, swelling or pus, you need to take your child to have a sore throat check with either a doctor or a nurse.

    Throat infections are a common childhood illness and most sore throats are viral infections which will get better without treatment. However, bacterial strep throat infections are more serious and need treatment with antibiotics to prevent complications, such as developing rheumatic fever.
     
  4. Is a sore throat a symptom of rheumatic fever?

    No. But an untreated strep sore throat can lead to rheumatic fever. This usually happens 1-5 weeks after the untreated strep throat infection.
     
  5. What is the treatment for strep throat?

    Strep throat is treated with antibiotics. This will stop it from turning into rheumatic fever.

    The antibiotics can be given in three ways – capsules, liquid, or as an injection that will be given by the doctor or nurse.

    If you child has the capsules or liquid, they are usually given for 10 days. It is important that your child takes all the antibiotics for the full 10 days, even if they feel better, to stop the strep throat from turning into rheumatic fever.

    Some children have trouble swallowing capsules. Read these tips to help children take medicine.

    If you think that your child will find it hard to take the medicine, or if it might be difficult to finish the full 10 days, an alternative is to ask the doctor or nurse to give your child an antibiotic injection. This will only need to be done once for this sore throat. If they get another sore throat later on, it will still need to be treated with antibiotics – capsules, liquid, or another injection.
     
  6. Why is it important to finish the full course of antibiotics?

    Antibiotics have been proven to effectively treat Group A Strep sore throats if the full 10 day course is taken. If the antibiotic treatment is not completed, the infection may not be stopped and could lead to the development of rheumatic fever. Taking the correct antibiotics for the full 10 days is important to prevent the development of rheumatic fever, even if sore throat symptoms are no longer present.
     
  7. Can I tell the difference between a strep throat and a common viral sore throat?

    No. It's hard to tell the difference between a strep throat and a common viral sore throat just by looking at it, so it is important to get it checked out by a doctor or nurse.

    They may take a swab from your child’s throat and send it to a lab. The lab will do a test to see whether your child has strep throat germs.

    If it is strep throat, it's important that the kids taking 10 days of antibiotics remember to take all the medicine, even if they feel better.
     
  8. How does strep throat spread?

    Strep throat is infectious and can spread when an infected person coughs or sneezes and others inhaling the infected cough and sneeze droplets.

    Families living in a cold damp home sometimes sleep in one room to keep warm or due to a lack of space. Sleeping close together in one room makes it easier for the strep throat cough and sneeze droplets to spread, which can lead to rheumatic fever.

    You can get rheumatic fever from a one-off throat infection, but repeated, untreated strep throat infections make it more likely.
     
  9. What can families do in their homes to try to stop strep throat from spreading to the rest of the family?

    Strep throat is infectious and can spread through cough and sneeze droplets. There are things that families can do in their homes to prevent infections like strep throat spreading to other family members.

    • Cover mouths when sneezing or coughing.

    • Put your used tissue in a lined rubbish bin or in a plastic bag

    • Wash and dry your hand often, especially after coughing or sneezing – use soap or hand gel

    • Try to create space between your children when they sleep, to limit the chance of strep throat germs being spread through coughs and sneezes. This is important all the time – not just when they are sick.
     
  10. Does everyone in the house need to be checked if one person has a positive strep throat swab?

    ‘Strep throat’ is infectious, so if one person in a household has it, it is possible that others could get it too.

    If you have someone in your home diagnosed with strep throat and anyone else aged between 3-35 years complains of a sore throat, it is important they get this sore throat checked to see if it is a strep throat.

    If they are given antibiotics, it’s important that they finish the full 10 days of antibiotics.

    By protecting the whole family from strep throat, we can reduce the chances of children and young people getting rheumatic fever.

    Sore throat clinics

  11. What is a sore throat clinic?

    Free sore throat clinic services are offered in areas where there is a high incidence of rheumatic fever.

    A sore throat clinic makes it easier for at-risk children and young people to get their sore throats checked and treated. At a sore throat clinic you can get your sore throat checked on the same day and receive free antibiotics if you need them.
     
  12. Who can get free sore throat clinic checks?

    • Maori and Pacific children and young people aged 4-19 years

    • 4-19 year olds living in low socio-economic communities

    • 3-35 year old household contacts (with a sore throat) of someone who has been treated for a strep throat infection
     
  13. Where can I get my child’s sore throat checked?

    • If you're in the Northland, Auckland city, Lakes, Waikato, Hawke's Bay, Bay of Plenty, Gisborne/East Coast, Porirua or the Hutt Valley areas and your child is Maori or Pacific, aged 4 to 19 years, and has a sore throat, they can have it checked at a free sore throat clinic

    o These are listed on the Ministry of Health's website

    o You can call Healthline on 0800 611 116 to find a clinic near you

    • You can go to your normal doctor or nurse. You may have to pay a fee. However, most general practices do not charge for visits of children aged under 13. You can phone ahead to check

    • Your child’s school may have a sore throat checking programme in place (contact the school to find out) – this service is free

    • Phoning your local general practice/family doctor for advice is one of the best ways to access the right care at the right time. Even if you call your practice overnight or outside of their normal opening hours, there are systems in place which provide nurse-led telephone services to help you sort out what you need and give advice

    Rheumatic Heart Disease

  14. How can rheumatic fever affect the heart?

    If your child has rheumatic fever, it may cause permanent damage to their heart valves. This is called rheumatic heart disease.

    A heart valve acts like a one-way door. It makes sure that blood pumped by the heart flows in one direction only. When the heart valve is damaged it can leak and may cause:

    • breathlessness

    • tiredness

    However, damage to the heart valves - rheumatic heart disease - may be permanent.
     
  15. What if my child also has rheumatic heart disease?

    If your child has damage to their heart valve they:

    • may need to stay in hospital for longer

    • will have penicillin injections for much longer

    • will need special care when visiting the dentist or dental therapist (nurse)

    • may eventually need surgery to repair the damaged valve

    Your doctor or nurse will speak to you about the care and treatment your child needs while they are in hospital.
     
  16. If my child has rheumatic heart disease, what can I do to help them stay healthy?

    You can help a child with rheumatic heart disease by:

    • Helping them look after their teeth and gums. This is very important if someone has rheumatic heart disease as they are at risk of developing an infection on their heart valves -- infective endocarditis. The bacteria that can cause infective endocarditis enter the bloodstream through injuries to the skin, lining of the mouth, or gums (including through dental and medical procedures)

    • Providing a diet low in sugar to prevent tooth decay

    • Encouraging water and milk as the drinks of choice rather than sugary drinks (including flavoured milk)

    • Reminding them about the importance of brushing their teeth twice a day with regular strength fluoride toothpaste — in the morning and before going to bed at night

    • Teaching the child to ‘Spit don’t rinse’ — by not rinsing toothpaste from the mouth after brushing, fluoride remains in contact with the teeth for longer and can more effectively prevent tooth decay

    • Emphasising the importance of visiting an oral health professional (dentist, dental therapist, dental hygienist) regularly for check-ups and having any required dental treatment completed. Dental care is free for those under 18 years old. For those over 18 years old, contact your local District Health Board for information on what support is available for getting regular dental care

    • Making sure the usual childhood immunisation schedule is maintained. Immunisations will prevent other illnesses that could have serious implications for their heart health, on top of rheumatic heart disease

    • Making sure the child has an annual flu vaccination, which is free for those with a history of heart disease

  17. Do other health professionals need to know if my child has rheumatic heart disease?

    Yes. It’s important that you tell any oral health professional (dentist, dental nurse, hygienist or therapist) or other health carer that your child has rheumatic heart disease.

    Your child will need antibiotics before most dental or surgical procedures to help stop them getting an infection on their heart valves. This is called infective endocarditis. The germs that cause infective endocarditis tend to come from the mouth and then enter the bloodstream through injuries to the skin, lining of the mouth, or gums (including through dental and medical procedures).

    You need to help your child to look after their teeth and avoid any infection.

    • Make sure your child brushes their teeth twice a day with regular strength fluoride toothpaste – in the morning and before going to bed at night

    • A diet low in sugar is important to prevent tooth decay

    • Have dental checks every six months.

    If you have any more questions please call Healthline on 0800 611 116 for free advice from trained registered nurses.

 

 

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