Epidemiological and Clinical Manifestations of Acute Rheumatic Fever in Far North Queensland, Australia

Abstract

We used the Queensland acute rheumatic fever (ARF) and rheumatic heart disease (RHD) register to describe the clinical phenotype and the characteristics of individuals diagnosed with ARF in Far North Queensland, Australia, between January 2012 and December 2023. There were 830 episodes of ARF in 740 individuals during the study period; 785/830 (95%) episodes occurred in First Nations Australians and 696/824 occurred in areas of socioeconomic disadvantage. There was no significant change in the overall incidence of ARF during the study period (Spearman's rho = 0.51, p = 0.09). The median (interquartile range) age of the cohort was 15 (10-23) years, although 276/830 (33%) episodes of ARF occurred in individuals ≥ 20 years. Individuals with carditis, polyarthritis, an abnormal electrocardiogram, fever and elevated inflammatory markers were more likely to have confirmed ARF. The presence of polyarthralgia, monoarthritis or skin manifestations was not associated with a diagnosis of confirmed ARF. Individuals with monoarthralgia were less likely to have confirmed ARF. At the end of the study period, 264/706 (37%) individuals who had access to echocardiography had confirmed RHD. Individuals who did not have echocardiography documented as a component of their initial episode of care were more likely to have severe RHD at the end of the study (25/339 (7%) versus 7/401 (2%), p < 0.0001). ARF and RHD continue to be diagnosed in First Nations Australians in tropical Australia. It seems unlikely that Australia will achieve its stated aim of eliminating RHD by 2031.