scholarly journals Searching for a technology-driven acute rheumatic fever test: the START study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053720
Author(s):  
Anna P Ralph ◽  
Rachel Webb ◽  
Nicole J Moreland ◽  
Reuben McGregor ◽  
Anthony Bosco ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Biomarker Discovery ◽  
Premature Mortality ◽  
Ethics Committee ◽  
Indigenous Australians ◽  
Department Of Health ◽  
Clinical Conditions ◽  
Biomarker Signature

IntroductionThe absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group A Streptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally.Methods and analysis‘Searching for a Technology-Driven Acute Rheumatic Fever Test’ (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5–30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention.Ethics and disseminationThe study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.

scholarly journals Estimating the risk of acute rheumatic fever in New Zealand by age, ethnicity and deprivation

2016 ◽  
Vol 144 (14) ◽  
pp. 3058-3067 ◽  
Author(s):  
J. K. GURNEY ◽  
J. STANLEY ◽  
M. G. BAKER ◽  
N. J. WILSON ◽  
D. SARFATI
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Strong Association ◽  
School Age Children ◽  
Disease Notification ◽  
Population Count ◽  
Specific Risk ◽  
Demographic Risk ◽  
Demographic Risk Factors

SUMMARYIn New Zealand, efforts to control acute rheumatic fever (ARF) and its sequelae have focused on school-age children in the poorest socioeconomic areas; however, it is unclear whether this approach is optimal given the strong association with demographic risk factors other than deprivation, especially ethnicity. The aim of this study was to estimate the stratum-specific risk of ARF by key sociodemographic characteristics. We used hospitalization and disease notification data to identify new cases of ARF between 2010 and 2013, and used population count data from the 2013 New Zealand Census as our denominator. Poisson logistic regression methods were used to estimate stratum-specific risk of ARF development. The likelihood of ARF development varied considerably by age, ethnicity and deprivation strata: while risk was greatest in Māori and Pacific children aged 10–14 years residing in the most extreme deprivation, both of these ethnic groups experienced elevated risk across a wide age range and across deprivation levels. Interventions that target populations based on deprivation will include the highest-risk strata, but they will also (a) include groups with very low risk of ARF, such as non-Māori/non-Pacific children; and (b) exclude groups with moderate risk of ARF, such as Māori and Pacific individuals living outside high deprivation areas.

scholarly journals Mathematical Modelling of Acute Rheumatic Fever

2021 ◽  
Author(s):  
◽  
Melissa Welsh
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
New Zealand ◽  
Mathematical Modelling ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Treatment Strategies ◽  
Developed Countries ◽  
Deterministic Methods ◽  
The World

<p>Acute rheumatic fever is a major cause of heart disease in many parts of the world. Though it is generally considered rare in developed countries, is remains a large issue in New Zealand. Of particular concern is the prevalence of acute rheumatic fever among Maori and Paci c Island peoples. In this thesis we develop a model to simulate acute rheumatic fever in a population. We discuss the use of both deterministic methods and stochastic processes. Demographics and statistics speci c to New Zealand are then used to develop the model in a way that ts speci cally to the situation in New Zealand. We also consider the introduction of treatment strategies for acute rheumatic fever and discuss how risk factors can be used to focus such strategies.</p>

scholarly journals Ethnically Disparate Disease Progression and Outcomes among Acute Rheumatic Fever Patients in New Zealand, 1989–2015

2021 ◽  
Vol 27 (7) ◽  
Author(s):  
Jane Oliver ◽  
Oliver Robertson ◽  
Jane Zhang ◽  
Brooke L. Marsters ◽  
Dianne Sika-Paotonu ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Disease Progression ◽  
Acute Rheumatic Fever

Epidemiology of acute rheumatic fever in New Zealand 1996-2005

2008 ◽  
Vol 44 (10) ◽  
pp. 564-571 ◽  
Author(s):  
Richard Jaine ◽  
Michael Baker ◽  
Kamalesh Venugopal
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever

scholarly journals Risk Factors for Acute Rheumatic Fever: Literature Review and Protocol for a Case-Control Study in New Zealand

2019 ◽  
Vol 16 (22) ◽  
pp. 4515 ◽  
Author(s):  
Michael G Baker ◽  
Jason Gurney ◽  
Jane Oliver ◽  
Nicole J Moreland ◽  
Deborah A Williamson ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Group A Streptococcus ◽  
Case Control ◽  
Case Definition ◽  
First Episode ◽  
The North ◽  
Wide Range

Acute rheumatic fever (ARF) and its sequela, rheumatic heart disease (RHD), have largely disappeared from high-income countries. However, in New Zealand (NZ), rates remain unacceptably high in indigenous Māori and Pacific populations. The goal of this study is to identify potentially modifiable risk factors for ARF to support effective disease prevention policies and programmes. A case-control design is used. Cases are those meeting the standard NZ case-definition for ARF, recruited within four weeks of hospitalisation for a first episode of ARF, aged less than 20 years, and residing in the North Island of NZ. This study aims to recruit at least 120 cases and 360 controls matched by age, ethnicity, gender, deprivation, district, and time period. For data collection, a comprehensive pre-tested questionnaire focussed on exposures during the four weeks prior to illness or interview will be used. Linked data include previous hospitalisations, dental records, and school characteristics. Specimen collection includes a throat swab (Group A Streptococcus), a nasal swab (Staphylococcus aureus), blood (vitamin D, ferritin, DNA for genetic testing, immune-profiling), and head hair (nicotine). A major strength of this study is its comprehensive focus covering organism, host and environmental factors. Having closely matched controls enables the examination of a wide range of specific environmental risk factors.

Acute rheumatic fever in Auckland, New Zealand

1994 ◽  
Vol 13 (4) ◽  
pp. 264-268 ◽  
Author(s):  
DIANA R. MARTIN ◽  
LESLEY M. VOSS ◽  
SUSAN J. WALKER ◽  
DIANA LENNON
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever

scholarly journals Acute rheumatic fever and exposure to poor housing conditions in New Zealand: A descriptive study

2017 ◽  
Vol 53 (4) ◽  
pp. 358-364 ◽  
Author(s):  
Jane R Oliver ◽  
Nevil Pierse ◽  
Niki Stefanogiannis ◽  
Catherine Jackson ◽  
Michael G Baker
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Descriptive Study ◽  
Housing Conditions

scholarly journals Preceding group A streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand

2021 ◽  
Vol 6 (12) ◽  
pp. e007038
Author(s):  
Jane Oliver ◽  
Julie Bennett ◽  
Sally Thomas ◽  
Jane Zhang ◽  
Nevil Pierse ◽  
...  
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Population Level ◽  
Gas Detection ◽  
Positive Skin ◽  
Group A ◽  
Dispensing Data

IntroductionAcute rheumatic fever (ARF) is usually considered a consequence of group A streptococcus (GAS) pharyngitis, with GAS skin infections not considered a major trigger. The aim was to quantify the risk of ARF following a GAS-positive skin or throat swab.MethodsThis retrospective analysis used pre-existing administrative data. Throat and skin swab data (1 866 981 swabs) from the Auckland region, New Zealand and antibiotic dispensing data were used (2010–2017). Incident ARF cases were identified using hospitalisation data (2010–2018). The risk ratio (RR) of ARF following swab collection was estimated across selected features and timeframes. Antibiotic dispensing data were linked to investigate whether this altered ARF risk following GAS detection.ResultsARF risk increased following GAS detection in a throat or skin swab. Māori and Pacific Peoples had the highest ARF risk 8–90 days following a GAS-positive throat or skin swab, compared with a GAS-negative swab. During this period, the RR for Māori and Pacific Peoples following a GAS-positive throat swab was 4.8 (95% CI 3.6 to 6.4) and following a GAS-positive skin swab, the RR was 5.1 (95% CI 1.8 to 15.0). Antibiotic dispensing was not associated with a reduction in ARF risk following GAS detection in a throat swab (antibiotics not dispensed (RR: 4.1, 95% CI 2.7 to 6.2), antibiotics dispensed (RR: 4.3, 95% CI 2.5 to 7.4) or in a skin swab (antibiotics not dispensed (RR: 3.5, 95% CI 0.9 to 13.9), antibiotics dispensed (RR: 2.0, 95% CI 0.3 to 12.1).ConclusionsA GAS-positive throat or skin swab is strongly associated with subsequent ARF, particularly for Māori and Pacific Peoples. This study provides the first population-level evidence that GAS skin infection can trigger ARF.

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