WA rheumatic heart disease register

Statutory notification

Acute rheumatic fever

  • Complete a EDPH approved form ARF notification form (PDF 184KB)
  • Provide a copy of each diagnostic test (including an echocardiogram)
  • The time frame during the Acute Phase is within 14 days of receiving test results – otherwise within 30 days of receiving test results
  • Provide a copy of each medical specialist’s report
  • The time frame during the Acute Phase is within 14 days of the specialist finalising the report – otherwise within 30 days of the specialist finalising the report

You must also ensure the following personal information on the patient is provided

  • full name, address and contact details
  • if the patient is under 18 years of age, the full name and address of a parent or guardian
  • their sex and date of birth
  • if known, the patient’s ethnicity, including if they are of Aboriginal or Torres Straits Islander descent.

You may be requested for further information.

Rheumatic heart disease

Name and contact details of person giving the notice.

  • Provide a copy of each diagnostic test (including an echocardiogram) – within 30 days of receiving test results
  • Provide a copy of each medical specialist’s report – within 30 days of the specialist finalising the report

You must also ensure the following personal information on the patient is provided

  • full name, address and contact details
  • if the patient is under 18 years of age, the full name and address of a parent or guardian
  • their sex and date of birth
  • if known, the patient’s ethnicity, including if they are of Aboriginal or Torres Straits Islander descent.

You may be requested for further information.

How to notify

Notification is given to the WA RHD Register and Control Program, under delegated duties of the EDPH Notifications are submitted by fax 91935260 from health service providers outside Department of Health or by fax or email RHDRegister@health.wa.gov.au for health service providers within Department of Health.

Limited disclosure

Health professionals need to inform patients that it is a statutory requirement to send information to the WA RHD Register. A patient may request in writing limited disclosure of identifying information available to health sites and health professionals.

Public health action

Important information

The Public Health importance of ARF relates to its ability to cause permanent damage to heart valves. Regular, long-term antibiotic prophylaxis to prevent recurrent attacks of ARF is the mainstay of rheumatic heart disease prevention in people who have already had one episode. See below guidelines.

Case definition ARF

A confirmed case of ARF is based on the identification of major and minor clinical manifestations of the disease as detailed by the modified Jones criteria (refer to the Australian guidelines: diagnosis of acute rheumatic fever (external PDF 950KB). There is no diagnostic laboratory test.

Initial episode of acute rheumatic fever:

As stated in the Australian guidelines: diagnosis of acute rheumatic fever an initial episode of ARF is defined as having:

  1. two major manifestations and evidence of a preceding Group A Streptococcus  (GAS) infectiona
    OR
  2. one major and two minor manifestations and evidence of a preceding GAS infectiona

Recurrent episode of ARF

A recurrent episode of ARF in a patient with known past ARF or rheumatic heart disease is defined as having:

  1. two major manifestations and evidence of a preceding GAS infectiona
    OR
  2. one major and two minor manifestations and evidence of a preceding GAS infectiona
    OR
  3. three minor manifestations and evidence of a preceding GAS infectiona

Probable acute rheumatic fever (initial or recurrent)

  1. A clinical presentation that falls short by either 1 Major or 1 Minor manifestation
    OR
  2. the absence of streptococcal serology results, but one in which acute rheumatic fever is considered the most likely diagnosis.
a Gas definition: Elevated or rising antistreptolysin O or other streptococcal antibody, or a positive throat culture or rapid antigen test for GAS

Table 1: Manifestations of acute rheumatic fever1

High-risk groupsi

All other groupsi

Major manifestations Carditis (including subclinical evidence of rheumatic valvulitis on echocardiogram) Carditis (excluding subclinical evidence of rheumatic valvulitis on echocardiogram)
Polyarthritisii or aseptic mono-arthritis or polyarthalgia Polyarthritisii
Choreaiii Choreaiii
Erythema marginatumiv Erythema marginatumiv
Subcutaneous nodules Subcutaneous nodules
Minor manifestations Monoarthralgia Polyarthralgia or aseptic mono-arthritis
Feverv Feverv
ESR > 30mm/h or CRP > 30mg/L ESR > 30mm/h or CRP > 30mg/L
Prolonged P-R interval on ECGvi Prolonged P-R interval on ECGvi

RHD Australia. Diagnosis of acute rheumatic fever (external PDF 950KB)

Notes on interpreting this table

[i] High-risk groups are those living in communities with high rates of ARF (incidence >30/100,000 per year in 5–14 year olds) or RHD (all-age prevalence >2/1000). Aboriginal people and Torres Strait Islanders living in rural or remote settings are known to be at high risk. Data are not available for other populations, but Aboriginal people and Torres Strait Islanders living in urban settings, Maoris and Pacific Islanders, and potentially immigrants from developing countries, may also be at high risk.

Low risk groups include all other populations.

ii A definite history of arthritis is sufficient to satisfy this manifestation. Note that if polyarthritis is present as a major manifestation, polyarthralgia or aseptic mono-arthritis cannot be considered an additional minor manifestation in the same person.

iii Chorea does not require other manifestations or evidence of preceding GAS infection, provided other causes of chorea are excluded.

iv Care should be taken not to label other rashes, particularly non-specific viral exanthemas, as erythema marginatum

v Oral, tympanic or rectal temperature > 38C on admission or a reliably reported fever documented during the current illness.

vi If carditis is present as a major manifestation, a prolonged P-R interval cannot be considered an additional minor manifestation.

CRP, C-reactive protein; ECG, electrocardiogram; ESR, erythrocyte sedimentation rate.

Guidelines

Notifiable disease data and reports

Patient advice

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Public Health