title: A national prospective surveillance study of acute rheumatic fever in Australian children.
abstract: BACKGROUND
  Acute rheumatic fever (ARF) is an important cause of heart disease in Indigenous people of northern and central Australia. However, little is known about ARF in children across all Australian population groups. This national prospective study was conducted to determine patterns of disease, and populations and regions at highest risk.
  
  
  METHODS
  The Australian Paediatric Surveillance Unit surveillance model was used to collect data on children with ARF across Australia. Children up to 15 years of age were included if they had an ARF episode diagnosed between October 1, 2007 and December 31, 2010 that met the case definition.
  
  
  RESULTS
  ARF was identified in 151 children: 131 Indigenous Australians, 10 non-Indigenous Australians, 8 Pacific Islanders and 1 African (1 unknown). Common presenting features were joint symptoms, fever and carditis. Sydenham chorea was reported in 19% of children. Aseptic monoarthritis was a major manifestation in 19% of high-risk children. Seven non-Indigenous Australian children presented with classic, highly specific features compared with 23% of high-risk children, suggesting that subtle presentations of ARF are being missed in non-Indigenous children. Recent sore throat was reported in 33% of cases, including 25% of remote Indigenous children. There were delays in presentation to care and referral to higher-level care across urban/rural and remote areas.
  
  
  CONCLUSIONS
  ARF may be more common than previously thought among low-risk children. These data should prompt an awareness of ARF diagnosis and management across all regions, including strategies for primary prevention. There should be renewed emphasis on treatment of sore throat in high-risk groups.
authors.affiliation: Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia. sara.noonan@menzies.edu.au
authors.forename: Sara
authors.initials: S
authors.lastname: Noonan
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Zurynski
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.forename: Malcolm
authors.initials: M
authors.lastname: McDonald
authors.forename: Gavin
authors.initials: G
authors.lastname: Wheaton
authors.forename: Michael
authors.initials: M
authors.lastname: Nissen
authors.forename: Nigel
authors.initials: N
authors.lastname: Curtis
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
authors.forename: Peter
authors.initials: P
authors.lastname: Richmond
authors.forename: James M
authors.initials: JM
authors.lastname: Ramsay
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Carapetis
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012008:Recurrence; D012213:Rheumatic Fever / Q000175:diagnosis / Q000453:epidemiology*; D012307:Risk Factors