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Rheumatic fever (acute)

Fact sheets

The Department of Health, Western Australia, does not produce fact sheets on this topic.

Public Health action

Acute rheumatic fever (ARF) has been notifiable in Western Australia since September 2007. (Not nationally notifiable)

The Public Health importance of ARF relates to its ability to cause permanent damage to heart valves. Regular, long-term antibiotic prophylaxis to prevent recurrent attacks of ARF is the mainstay of rheumatic heart disease prevention in people who have already had one episode. See below guidelines.

How to notify

The statutory requirement to notify acute rheumatic fever is specified in Part IXA of the Health Act 1911 and subsidary regulations.

All notifications should be faxed or emailed to the Rheumatic Heart Disease (RHD) Control Program Team at the Kimberley Population Health Unit, which is responsible for the collection and management of all ARF notifications in WA. Only the first notification of an ARF episode (regardless of whether it is an initial or recurrent episode) is entered into the Western Australian Notifiable Infectious Disease Database (WANIDD). All reported episodes of ARF for an individual are entered into the Western Australian RHD Register, which serves a clinical purpose

Notifications should be made using the acute rheumatic fever notification form (PDF 197KB) 

Notifiable disease data and reports

For more information

Case definition

Reporting

Only confirmed cases should be notified.

Confirmed case

A confirmed case of ARF is based on the identification of major and minor clinical manifestations of the disease as detailed by the modified Jones criteria (refer to the Australian guidelines: diagnosis of acute rheumatic fever (PDF 950KB). There is no diagnostic laboratory test. 

Initial episode of acute rheumatic fever:

As stated in the Australian guidelines: diagnosis of acute rheumatic fever (PDF 950 KB) an initial episode of ARF is defined as having:

1.Two major manifestations and evidence of a preceding Group A Streptococcus  (GAS) infectiona

OR

2. One major and two minor manifestations and evidence of a preceding GAS infectiona

Recurrent episode of ARF:

A recurrent episode of ARF in a patient with known past ARF or rheumatic heart disease is defined as having:

1. Two major manifestations and evidence of a preceding GAS infectiona

OR

2. One major and two minor manifestations and evidence of a preceding GAS infectiona

OR

3. Three minor manifestations and evidence of a preceding GAS infectiona

Probable acute rheumatic fever (initial or recurrent)

1. A clinical presentation that falls short by either 1 Major or 1 Minor manifestation,

OR

2. The absence of streptococcal serology results, but one in which acute rheumatic fever is considered the most likely diagnosis.

 a Gas definition: Elevated or rising antistreptolysin O or other streptococcal antibody, or a positive throat culture or rapid antigen test for GAS

Manifestations of acute rheumatic fever

High-risk groupsi

All other groupsi

Major manifestations

  • Carditis (including subclinical evidence of rheumatic valvulitis on echocardiogram)
  • Polyarthritisii or aseptic mono-arthritis or polyarthalgia
  • Choreaiii
  • Erythema marginatumiv
  • Subcutaneous nodules
  • Carditis (excluding subclinical evidence of rheumatic valvulitis on echocardiogram)
  • Polyarthritisii
  • Choreaiii
  • Erythema marginatumiv
  • Subcutaneous nodules

Minor manifestations

  • Monoarthralgia
  • Feverv
  • ESR > 30mm/h or CRP > 30mg/L
  • Prolonged P-R interval on ECGvi
  • Polyarthralgia or aseptic mono-arthritis
  • Feverv
  • ESR > 30mm/h or CRP > 30mg/L
  • Prolonged P-R interval on ECGvi

Notes on interpreting this table
High-risk groups
are those living in communities with high rates of ARF (incidence >30/100,000 per year in 5–14 year olds) or RHD (all-age prevalence >2/1000). Aboriginal people and Torres Strait Islanders living in rural or remote settings are known to be at high risk. Data are not available for other populations, but Aboriginal people and Torres Strait Islanders living in urban settings, Maoris and Pacific Islanders, and potentially immigrants from developing countries, may also be at high risk. Low risk groups include all other populations. 
ii A definite history of arthritis is sufficient to satisfy this manifestation. Note that if polyarthritis is present as a major manifestation, polyarthralgia or aseptic mono-arthritis cannot be considered an additional minor manifestation in the same person.
iii Chorea does not require other manifestations or evidence of preceding GAS infection, provided other causes of chorea are excluded.
iv Care should be taken not to label other rashes, particularly non-specific viral exanthemas, as erythema marginatum
v Oral, tympanic or rectal temperature > 38C on admission or a reliably reported fever documented during the current illness.
vi If carditis is present as a major manifestation, a prolonged P-R interval cannot be considered an additional minor manifestation.
CRP, C-reactive protein; ECG, electrocardiogram; ESR, erythrocyte sedimentation rate. 
 

 

Alerts

 Statutory notification alert


See the Statutory Notifications Website for reference.

For the Perth metropolitan residents, please use this form: Perth metropolitan communicable disease statutory notification form (PDF 209KB) and mail or fax to the Communicable Disease Control Directorate.

For regional WA residents, please use this form: Regional communicable disease statutory notification form (PDF 209KB) and mail or fax to the appropriate regional Public Health Unit.

 

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