title: First Presentation Acute Rheumatic Fever is Preventable in a Community Setting: A School-based Intervention.
abstract: BACKGROUND
  Robust evidence is lacking for community initiatives to prevent first presentation acute rheumatic fever (ARF) by group A streptococcal (GAS) pharyngitis treatment.
  
  
  METHODS
  We measured the effect of introducing a sore throat clinic program on first presentation ARF into 61-year 1-8 schools with students 5-13 years of age (population ≈25,000) in Auckland, New Zealand. The study period was 2010-2016. A generalized linear mixed model investigated ARF rate changes before and after the staggered introduction of school clinics. Nurses and lay workers treated culture-proven GAS sore throats (including siblings) with 10 days of amoxicillin. ARF cases were identified from a population-based secondary prophylaxis register. Annual pharyngeal GAS prevalence was assessed in a subset.
  
  
  RESULTS
  ARF rates in 5-13 year olds dropped from 88 [95% confidence interval (CI): 79-111] per 100,000 preclinics to 37 (95% CI: 15-83) per 100,000 after 2 years of clinic availability, a 58% reduction. No change in rate was demonstrated before the introduction of clinics [P = 0.88; incidence risk ratio for a 1-year change: 0.98 (95% CI: 0.63-1.52)], but there was a significant decrease of first presentation ARF rates with time after the introduction of the sore throat program [P = 0.008; incidence risk ratio: 0.61 (95% CI: 0.43-0.88)]. Pharyngeal GAS cross-sectional prevalence fell from 22.4% (16.5-30.5) preintervention to 11.9% (8.6-16.5) and 11.4% (8.2-15.7) 1 or 2 years later (P = 0.005).
  
  
  CONCLUSIONS
  ARF declined significantly after school-based GAS pharyngitis management using oral amoxicillin paralleled by a decline in pharyngeal GAS prevalence.
authors.affiliation: From the *Department of Pediatrics, University of Auckland, †Division of Pediatric Infectious Diseases, Starship Children's Hospital, Auckland District Health Board, ‡Division of Child Health, Kids First Public Health Nursing, Kidz First Community, and §Division of Population Health, Counties Manukau District Health Board, Auckland, New Zealand; ¶Division of Funding and Planning, Canterbury and West Coast District Health Board, Christchurch, New Zealand; ‖Invercargill Medical Centre, Invercargill, New Zealand; **National Hauora Coalition, and ††Division of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
authors.forename: Diana
authors.initials: D
authors.lastname: Lennon
authors.forename: Philippa
authors.initials: P
authors.lastname: Anderson
authors.forename: Melissa
authors.initials: M
authors.lastname: Kerdemilidis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Farrell
authors.forename: Suzanne
authors.initials: S
authors.lastname: Crengle Mahi
authors.forename: Teuila
authors.initials: T
authors.lastname: Percival
authors.forename: David
authors.initials: D
authors.lastname: Jansen
authors.forename: Joanna
authors.initials: J
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections; D003430:Cross-Sectional Studies; D006801:Humans; D009520:New Zealand / Q000453:epidemiology; D010614:Pharynx / Q000382:microbiology; D011322:Primary Prevention / Q000379:methods / Q000706:statistics & numerical data; D012213:Rheumatic Fever / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012574:Schools; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D013297:Streptococcus pyogenes; D013334:Students / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin