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Rheumatic Heart Disease Australia

RHD Resouces

Health Alert Fact Checked

Health Alert - 2.9.2021

Increase in Acute Rheumatic Fever (ARF) in East Arnhem region prompts heightened awareness for recognising signs and symptoms of ARF in your practice and ensuring those in your care requiring penicillin prophylaxis for ARF/RHD are receiving it.

In the past 28 days there has been an increase in Acute Rheumatic Fever (ARF) cases in the East Arnhem region. This is an unusual pattern of ARF and while Acute Rheumatic Fever is not usually known to occur in outbreaks, it warrants a public health response to rule out a potentially virulent strain and to reduce any potentially higher than normal background level of Group A Streptococcus (GAS).

It is recommended that all health services in the Top End follow these actions:

  • All regional and primary and specialist clinical staff should be advised of the increase in ARF in the community with a heightened clinical suspicion for pursing for investigation
  • Urgency should be applied to ensure all patients who are prescribed secondary prophylaxis with benzathine penicillin in your community or practice are up to date.
  • Clinical priority should be given to primary prevention: treat all sore throats and skin sores as per CARPA. Sore throat CARPA p407; Skin Infections CARPA p387
  • All suspected cases of ARF in the next month (4 weeks) should be notified as soon as possible to the NT RHD Register

Acute Rheumatic Fever (ARF)

Acute Rheumatic Fever (ARF) is an illness caused by an autoimmune response following infection with GAS of the skin or throat. Acute episodes occur 2-3 weeks after exposure to GAS.
Be alert for signs and symptoms of ARF including:

  • fever
  • painful or swollen joints
  • chorea (up to 6 months post exposure)
  • new murmur
  • shortness of breath
  • signs of heart failure
  • prolonged PR interval on ECG

Hospitalisation is recommended within 24-72 hours for all cases of suspected ARF for clinical assessment and confirmation of diagnosis.
Local protocols can be accessed at ARF CARPA p294

Additional resources:

The ARF Diagnosis App for iOS and Android available
Online clinical modules are available here.
2020 Australian guideline for prevention, diagnosis and management of ARF and RHD 

NT RHD Rheumatic Heart Disease Control Program - Top End Region 8922 8454 rhddarwin@nt.gov.au

Thank you for being alert to ARF. Early diagnosis allows for best management and public health actions to reduce further transmission of GAS. It is very important, now and always, to be a champion for promoting good hygiene and healthy skin practices.