Acute rheumatic fever spike in a remote Aboriginal community in the Northern Territory: another challenge to Closing The Gap initiatives

Background: Rheumatic Heart Disease (RHD) remains a significant health issue for the Aboriginal population of the Northern Territory (NT) with one of the highest rates of acute rheumatic fever (ARF) in the world. Remote Aboriginal patients have inadequate access to both cardiac diagnostics and therapeutic interventions. Aim: To describe the characteristics, public health and clinical challenges of a significant number of cases over a short period of time in an Aboriginal community in the NT. Method: In September 2014, a clinic in an Aboriginal community reported higher than expected number of ARF cases and apparent clustering within households. We describe these cases including those requiring transfer interstate for urgent valve surgery. Results: There were 13 cases of definite ARF during a 4-month period compared with an expected 2.2 for that period (6.6 cases per year). This is on a background of 108 RHD cases currently on secondary prophylaxis in a population that approximates 2800. This increase in number of ARF cases required a coordinated public health and clinical team response. Conclusion: ARF and its recurrence are preventable. The increase in number of ARF cases in this already disadvantaged population resulted in significant stress to the affected households, community clinic staff, specialist clinicians and public health system. More must be done to eradicate this disease if we genuinely intend Closing The Gap.