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  • Title: A cluster of acute rheumatic fever cases among Aboriginal Australians in a remote community with high baseline incidence.
    Author: Francis JR, Gargan C, Remenyi B, Ralph AP, Draper A, Holt D, Krause V, Hardie K.
    Journal: Aust N Z J Public Health; 2019 Jun; 43(3):288-293. PubMed ID: 30994967.
    Abstract:
    OBJECTIVES: We report a cluster of acute rheumatic fever (ARF) cases and the public health response in a high-burden Australian setting. METHODS: The public health unit was notified of an increase in ARF cases in a remote Australian Aboriginal community. A multi-disciplinary group coordinated the response. Household contacts were screened for ARF or group A Streptococcus (GAS) infection by questionnaire and swab collection, offered an echocardiogram if aged 5-20 years, and intramuscular benzathine benzylpenicillin if aged over one year or if less than one year with impetigo. RESULTS: Fifteen definite and seven probable ARF cases were diagnosed in the community in July-December 2014 (all-age incidence of definite ARF: 1,473/100,000). The public health response identified two additional cases of ARF. A total of 81 contacts were screened; GAS was detected in 3/76 (4%) throat swabs and 11/24 (46%) skin swabs. Molecular typing revealed high GAS strain diversity. CONCLUSIONS: The incidence of ARF during this cluster was very high. Carriage and infection with GAS was observed, but no outbreak strain identified. Implications for public health: A national public health guideline has since been developed that includes advice on the investigation of an ARF outbreak/cluster. Sustained efforts with strong community engagement are required to tackle high ARF rates.
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