Rheumatic Heart Disease in Aboriginal Australia

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Acute Rheumatic Fever (ARF) is a condition that may occur after an infection with Group A Streptococcus bacteria in the throat or skin. Multiple episodes of ARF can cause a persistent injury to the heart valves resulting in Rheumatic Heart Disease (RHD), 

But in Australia, highest reported rates of RHD are found in remote Indigenous communities including Aboriginal and Torres Strait Islander people, Maori and Pacific Islander people. Children between the ages of 5 and 14 are most commonly affected by acute rheumatic fever.

Causes and Transmission

In remote Indigenous communities, children often face the challenges of poverty and limited access to healthcare. As a result, they are prone to experiencing frequent and chronic infections caused by strep A bacteria. The transmission of strep A through skin-to-skin contact plays a significant role in disease spread in such overcrowded living conditions. Unfortunately, if left untreated, these recurring infections can lead to the development of acute rheumatic fever, an inflammatory condition affecting the heart.

When acute rheumatic fever recurs frequently over a long period of time, typically causing irreversible valve damage and developing into Rheumatic Heart Disease (RHD).

The heart’s cardiac valves function as doors that only let blood flow in one direction. The valves allow blood to leak in the wrong direction when they are damaged. This lessens the heart’s capacity to pump blood efficiently, which eventually causes heart failure, strokes, and occasionally even premature death.

Although there can be several reasons for weak heart health, you can discover more about Cardiomyopathy and try the Cardiovascular Disease risk calculator below yourself.


If your child has any of the following signs it could be rheumatic fever:

  • sore or swollen joints (knees, ankles, elbows, wrists)
  • a fever
  • a skin rash (on the trunk, arms and legs)
  • jerky movements and difficulty walking
  • lumps under the skin (elbow, wrist, knees and ankles).

If your child has any of these signs or symptoms, they need to be brought to the clinic or hospital for tests. This is the only way to know for certain if it is acute rheumatic fever.


At various stages along the process, the progression of rheumatic heart disease and associated complications can be halted. It is possible to avoid developing acute rheumatic fever if the original strep infection is correctly identified and rapidly treated with the antibiotic penicillin.

Step 1: Primordial Prevention

In order to address ARF and RHD, it is crucial to prevent Group A streptococcal infections, which can result in the disease. By addressing environmental factors that are known to raise the risk of infection, such as deprivation, overcrowding, and substandard housing, streptococcal infections can be avoided. This is called Primordial prevention.

 Rheumatic heart disease prevention guidelines
Healthy Living Practices and their association with Strep A infections, ARF and RHD according to RHDAustralia Guidelines 2020.
Step 2: Treating Sore Throats

ARF risk can be further decreased in high-risk people by promptly and effectively treating sore throats. Healthcare professionals and high-risk people must be informed about how to treat sore throats. ARF episodes in RHD-affected communities may also be brought on by group A streptococcus skin infections. 

Step 3: Treating ARF

To stop more heart damage from causing severe RHD, it’s crucial to prevent recurrent episodes of ARF. Patients with ARF or RHD are advised to receive injections of the antibiotic benzathine penicillin G every 21-28 days. This regimen should be followed for at least ten years after the last episode of ARF, and it might be necessary for longer.

Step 4: Surgery 

It is possible action to take if acute rheumatic fever develops. Surgery can be required to replace or even repair a severely damaged heart valve. Despite the fact that surgery cannot cure rheumatic heart disease, it can nevertheless save lives.

You must speak with your doctor, nurse, Aboriginal health worker, or call your local public health unit at 1300 066 055 for a more thorough perspective.

How can I stop my child or family member from having another episode of acute rheumatic fever?

Regular penicillin injections is the most effective approach to prevent another episode of acute rheumatic fever in your child or family. These injections should be given every 28 days and are typically given in the thigh or bottom of the child. Trained clinic staff will be responsible for administering the penicillin injections, and they will work closely with you and your family to ensure the consistent and timely administration of these injections.

What else do I need to know if my child has rheumatic heart disease?

Taking care of your child’s teeth through routine brushing and dental checkups is crucial to preventing infections and maintaining good oral health, especially if they have rheumatic heart disease. The dentist should be made aware of the problem as further antibiotics may be needed before the session to prevent further harm to the heart.

Will my child or family member be able to lead a normal life?

The majority of children with rheumatic fever lead normal lives with the right care and regular penicillin injections. Making ensuring your child never experiences another case of acute rheumatic fever is important. The only way to accomplish this is to ensure that they receive regular injections of penicillin.

In conclusion, it is necessary to understand the significance of rheumatic heart disease and its effects on both individuals and society. We have looked at the causes, symptoms, and preventative steps for this treatable but serious ailment in this blog. Let’s keep spreading the word, emphasize early detection, and encourage easy access to high-quality medical care for persons with rheumatic heart disease.

For more detailed guidelines on ARF and RHD, you can read here or download following apps.

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