About acute rheumatic fever and rheumatic heart disease
Acute rheumatic fever (ARF) can occur following an infection caused by the group A streptococcus bacterium (Strep A). In high risk populations, an untreated Strep A infection (i.e. a 'strep throat' or skin infection) can lead to inflammation in other parts of the body, particularly the joints, brain and heart. Without regular antibiotic treatment, further episodes of ARF can lead to serious damage of the heart valves. This is known as rheumatic heart disease (RHD).
RHD is a chronic disease that if untreated can lead to complications including heart failure, arrhythmia and stroke and can cause significant morbidity and mortality. RHD can also cause complications in pregnancy that requires care planning and management.
The burden of disease often spans the majority of a person’s lifetime, starting with ARF in childhood, where ongoing active engagement with the healthcare system is needed for many years, and progressing in many cases to RHD and associated heart conditions during adulthood.
Despite being preventable, high rates of ARF and RHD persist across many countries, where social and cultural determinants of health are not addressed. In Australia, Aboriginal and Torres Strait Islander peoples experience some of the highest rates of RHD in the world, with RHD being a leading cause of cardiovascular inequity between First Nations people and non-indigenous Australians. High rates of ARF and RHD are also seen in Māori populations, and migrants from Pacific nations.
In Queensland, high rates of ARF and RHD are seen in the Torres and Cape, North West Queensland, Cairns and Hinterland and Townsville areas. From 2019-2023 more than half of the ARF cases occurred in children aged 5-14 years and 85% occurred in Aboriginal and Torres Strait Islander people. Approximately two-thirds of RHD cases are females and half are diagnosed with RHD before the age of 35 years.
High risk populations for ARF
In Australia, populations at high risk include:
- People living in an ARF-endemic setting;
- Aboriginal and/or Torres Strait Islander peoples living in rural or remote settings;
- Aboriginal and/or Torres Strait Islander peoples, and Māori and/or Pacific Islander peoples living in metropolitan households affected by crowding and/or lower socioeconomic status.
- Personal history of ARF/RHD and aged <40 years.
Populations who may be at high risk:
- Family or household recent history of ARF/RHD.
- Household overcrowding (2 or more people per bedroom) or low socioeconomic status.
- Migrant or refugee from low-or middle-income country and their children.
- Prior residence in, or frequent recent travel to a high ARF risk setting.
- Aged 5 to 20 years (peak years for ARF).
Prevention, diagnosis and management of ARF and RHD
View the Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease for standards, recommendations, and guidance.
Notifying ARF and RHD in Queensland
ARF and RHD are important public health issues and are notifiable conditions in Queensland under the Public Health Regulation 2018. Notifications should be made within 48 hours of suspected or confirmed diagnosis on the notification form for ARF (PDF 444 kB) and RHD (PDF 559 kB).
For more information on notifying ARF and RHD, refer to Communicable disease control guidance for ARF and RHD notifications or contact your local public health unit.
Surveillance reports
View Queensland Notifiable conditions reports for Acute Rheumatic Fever and Rheumatic Heart Disease.
State-wide data on notified cases are presented by notification date and can be sorted to show Hospital and Health service notifications.