Rheumatic fever and chronic rheumatic heart disease in Yarrabah aboriginal community, north Queensland. Establishment of a prophylactic program.
OBJECTIVE
To establish a program for the prevention of rheumatic fever and rheumatic heart disease in a semi-isolated Aboriginal community in far north Queensland and to test its efficacy.


METHODS
A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted in the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever.


METHODS
The Yarrabah Aboriginal community in north Queensland (latitude 17 degrees S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division.


METHODS
The whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4-16 year olds) were examined.


METHODS
After the 1985 survey, all community members aged 4-16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found.


RESULTS
Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three-month period.


CONCLUSIONS
These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of its success and this can be obtained by community education.
Neilson
G
G
Department of Cardiology, Prince Charles Hospital, Chermside, Qld.
Streatfield
R W
RW
West
M
M
Johnson
S
S
Glavin
W
W
Baird
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006306:Health Surveys; D006330:Heart Defects, Congenital / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000150:complications / Q000382:microbiology; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D012213:Rheumatic Fever / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012214:Rheumatic Heart Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000150:complications / Q000382:microbiology; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
D000900:Anti-Bacterial Agents