Rheumatic heart disease (RHD) is 100% preventable. It results when permanent damage to the heart valves develops after usually repeated episodes of acute rheumatic fever (ARF), an autoimmune reaction to an untreated Group A Streptococcus (GAS) infection. Heart failure, atrial fibrillation and stroke are common complications of RHD, associated with significant premature morbidity and mortality. Like HIV/AIDS, the GAS/ARF/RHD cascade is another example of infection becoming a chronic condition.

In Australia, these diseases primarily affect Aboriginal and Torres Strait Islander peoples in the north of the country (including Queensland) with some of the highest documented rates in the world. The rates may be even higher as there is likely to be under-diagnosis of ARF (notoriously difficult requiring a constellation of clinical criteria to be fulfilled) and underreporting as it is a clinically notifiable disease in Queensland.

However, an audit of hospital records by the Queensland RHD Register in 2015-2016 shows that areas outside north Queensland still have cases. While the issue occurs in Aboriginal and Torres Strait Islander peoples due to health and social disparities, health care providers should remember that these diseases also occur in other socially disadvantaged populations notably Pacific Islanders, Maoris and refugees/migrants.

Environmental settings with high incidence of GAS exposure are associated with socioeconomic deprivation such as overcrowding and poorly functioning health hardware to allow good hygiene. Combining poor carer health literacy (ARF mainly affects children aged 5-15 years) with a lack of access to appropriate health care for treatment of sore throats and skin sores can set the stage for ARF. This would then require long acting benzathine penicillin injections every 21-28 days (not monthly) for many years to prevent RHD. If these injections are not given at the appropriate intervals, then cases are put at risk of another GAS infection, episode of ARF and increasing likelihood of RHD.

RHD also become notifiable in Queensland in September 2018, so those requesting echocardiograms where this condition is identified now need to complete the notification form available on the internet and send to their local public health unit or the RHD Register - ArfRhdRegister@health.qld.gov.au  

These diseases are a quintessential marker of the poverty and inequity present in this country. In Queensland, all primary health care providers and specialists need to work together to prevent ARF and RHD in Queensland.