Te kirikā rūmātiki Rheumatic fever

Rheumatic fever usually starts 1 to 5 weeks after tamariki and rangatahi have had strep throat.

If they have any of the following symptoms, take them to your healthcare provider as soon as possible.

• Sore joints are the most common symptom of rheumatic fever. This includes the hip, knees, elbows, ankles and wrists. Different joints may be sore on different days. Sore joints may cause a limp or difficulty walking due to pain. 
• Joints may be red, swollen and feel hot.
• Shortness of breath — they may feel short of breath more easily than usual when they are active.
• A rash. 
• Small painless lumps under the skin over the elbows, wrists, knees, ankles or spine.
• Unusual jerky movements of their hands, feet, tongue and face. This can look like fidgeting or being unable to sit still, and can affect their handwriting. The movements stop during sleep.

Over time, most of these symptoms will go away. But, heart damage can be permanent.

Tamariki and rangatahi may also have:

• tummy pains
• weight loss
• extreme tiredness
• an ongoing fever at or greater than 38° C that lasts a few days. 

Rheumatic heart disease is a serious disease of the heart. It is caused by rheumatic fever and involves damage to one or more of the 4 small heart valves. Heart valve damage can remain after acute rheumatic fever. 

During rheumatic fever, the heart valve tissue and sometimes other parts of the heart (the heart lining or muscle) can become swollen, inflamed, or both (carditis). Following carditis, the heart valves can remain damaged then become scarred. The result is an interruption to normal blood flow through the damaged valves. When the heart is damaged this way, the heart valve is not able to function properly. This is called rheumatic heart disease. People with severe rheumatic heart disease may need surgery to repair or replace damaged heart valves.

Complications of rheumatic heart disease

Complications include heart failure, which means the heart is unable to pump blood effectively. The strain causes the heart to enlarge. Other complications of rheumatic heart disease include:

•  infection of damaged heart valves (infective endocarditis)
• stroke due to clots forming in the enlarged heart, or on damaged valves.

There are things that can be done to reduce the chances of getting rheumatic fever.

Māori or Pacific tamariki and rangatahi aged between 4 and 19 are most at risk of getting rheumatic fever, especially those with one or more of the following risk factors:

• family history of rheumatic fever, rheumatic heart disease or both
• household crowding
• experiencing barriers to accessing primary health care
• drinking sugar sweetened beverages daily.

Rheumatic fever is an autoimmune disease. The most common cause is from untreated, or partially treated, strep throat.

In some tamariki and rangatahi, the immune system response to strep infections also affects other parts of their body, their heart, skin, joints, and brain, causing the symptoms of rheumatic fever. Why this happens in some people and not others is unclear. There is no test that tells us who will have this immune response, and who will not.

If tamariki and rangatahi may have rheumatic fever, they will be admitted to hospital for some tests. These tests will confirm whether they have rheumatic fever or not. The tests may include:

• a blood test
• a throat swab
• an electrocardiogram (also known as an ECG, this records the electrical signal from the heart to check for different heart conditions)
• an echocardiogram (sound waves to show how blood flows through the heart and heart valves).

They may need to stay in hospital for quite a few days while the tests are completed.

Rheumatic fever has long-lasting consequences. Repeated episodes of rheumatic fever can make rheumatic heart disease worse.

To prevent more episodes of rheumatic fever that can lead to rheumatic heart disease, it is important to stop further strep throat infections. This is done by giving your tamariki and rangatahi penicillin injections every 28 days for at least 10 years, which can go into adulthood.

They will also need:

• time off school and not be able to exercise or play sports until their body has recovered — it is important they return to normal activity when it is determined safe by the medical team
• regular dental checks and extra care of teeth and gums
• an annual flu vaccine as well as the regular immunisations.

Immunisations

The flu vaccine is free for people who have rheumatic heart disease. Immunisations are important for people who have had rheumatic fever to prevent other illnesses which can affect heart health, like flu and COVID-19.

• Flu (influenza) vaccine (internal link)
• COVID-19 vaccine (internal link)

Services and support

Each health district has services to help coordinate the care for anyone on antibiotics for secondary prevention of acute rheumatic fever or rheumatic heart disease. A National Rheumatic Fever Care Coordination System is being developed to help support people living with rheumatic fever and rheumatic heart disease to receive this care no matter where they live in Aotearoa New Zealand.

Dentist visits

Looking after teeth and gums is very important if tamariki and rangatahi have had rheumatic fever. They are more at risk of developing an infection on their heart valves. Tell any oral health professional (dentist, dental nurse, hygienist or therapist), or other provider that your tamariki has had rheumatic fever or rheumatic heart disease.

Some tamariki and rangatahi may need antibiotics before having dental work done. This is to help reduce the chance of any infection reaching their heart during the dental procedure. Talk to your healthcare provider or dentist for more information.

Dental care is free for all tamariki and rangatahi up until their 18th birthday.

Visiting a dentist — Health New Zealand (external link)

Sore throat checks

If tamariki and rangatahi have a sore throat, it is important to get them checked out straight away. 

Where to get a sore throat checked

There are lots of places to get a sore throat checked. 

• You can go to your normal healthcare provider. Let them know your tamariki or rangatahi has a sore throat in case they have nurses available to respond quickly. 
• Pharmacies in some districts can do sore throat checks and treatment for high risk children and young adults.
• Your child's school may have a free sore throat checking programme. Contact the school to find out. 

If you have immediate concerns about your child's sore throat, you can also call Healthline on 0800 611 116

If tamariki and rangatahi have strep throat, they will be given antibiotics to clear up the infection before it can develop into rheumatic fever. A full course of antibiotics is 10 days. It is important they take the full course of antibiotics, even if they feel better. This makes it much less likely that strep throat will lead to rheumatic fever. 

Keep your home warm and dry

Keep your home warm and dry. Create as much space as possible to spread out around your home — rather than having to crowd in the same room.

Having more warm rooms and sleeping spaces available means germs like strep throat are less likely to spread.

Healthy Homes Initiative

The Healthy Homes Initiative identifies eligible families to work with to create a warmer, drier, healthier home. The Healthy Home Initiatives providers provide advocacy and education to the families, as well as support to get the interventions they need to create a better living environment, especially for their tamariki. Find out more on the Te Whatu Ora website.

Healthy Homes Initiative — Health New Zealand (external link)