Keywords:
Aboriginal, Australia, Rheumatic fever, Rheumatic heart disease
Abstract:
Globally, ARF and RHD cause more than a quarter of a million deaths and substantial disability each year. In Australia, Aboriginal and Torres Strait Islander people bear the greatest burden of disease.1 While illustrating the challenges that Indigenous Australians face, developments in ARF and RHD provide a focus for further work and grounds for cautious optimism. These include the development of a vaccine to prevent group A streptococcus (GAS) infection, better delivery of secondary antibiotic prophylaxis, and better management of advanced RHD.
The ultimate solution to ARF and RHD is primordial prevention of the social and environmental determinants of GAS infection. During the 20th century, ARF was largely borne by non-Indigenous Australian children in southern parts of Australia. The association between ARF and household crowding, and the dramatic reduction seen elsewhere in Australia, reinforces the need for a multifaceted response to disadvantage. While this remains the long-term focus, much can be achieved in the short-to-medium term.