Persistence of acute rheumatic fever in a tertiary children's hospital

Michael T. Smith, David Lester-Smith, Yvonne Zurynski, Sara Noonan, Jonathan R. Carapetis, Elizabeth J. Elliott

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Aim: To identify and describe all children admitted with acute rheumatic fever (ARF) to a tertiary paediatric hospital in Sydney over a 9-year period and to describe their demographic and clinical characteristics, management and short-term outcomes. Delays in diagnosis, recurrence of ARF and use of secondary prophylaxis were also documented. Methods: Retrospective review of medical records for children aged <15 years admitted to the Children's Hospital at Westmead, Sydney, with ARF (International Classification of Diseases (ICD)-10 classification I0.0-I09.9) during 2000-2008. Only cases meeting the National Heart Foundation of Australia diagnostic criteria for ARF were included. Results: Twenty-six children met the National Heart Foundation of Australia criteria for ARF. The median age was 11.5 years (range 5.8-14.6) and 15 (58%) were male. Ten (38%) identified as Pacific Islander, and 5 (19%) as Aboriginal and Torres Strait Islander (ATSI). Most (n= 20, 77%) lived in suburban Sydney, and 69% were classified in the two most disadvantaged quintiles on the Index of Relative Socioeconomic Disadvantage and Advantage. Four (15%) had Sydenham's chorea, and 81% had carditis (mitral and/or aortic regurgitation). Six (23%) children had previous ARF. Antibiotic prophylaxis to prevent recurrent ARF was prescribed in all cases, but 50% received oral penicillin, rather than by intramuscular injection. Barriers to timely diagnosis were identified in 81%, including delayed presentation and delayed referral. Conclusion: Most children presenting to the hospital with ARF lived in disadvantaged areas of Sydney. Pacific Islander and Aboriginal and Torres Strait Islander children were over-represented. Mitigation of RHD requires early identification of ARF and appropriate delivery of secondary prophylaxis.

Original languageEnglish
Pages (from-to)198-203
Number of pages6
JournalJournal of Paediatrics and Child Health
Issue number4
Publication statusPublished - 1 Apr 2011
Externally publishedYes


  • paediatrics
  • prevention and control
  • rheumatic fever
  • rheumatic heart disease


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