This section discusses diagnoses of acute rheumatic fever (ARF) reported by Australian RHD control programs between 2015 and 2019. The total number of ARF notifications recorded is dependent on the reporting practices to the various RHD registers. A person may have multiple diagnoses of ARF in their lifetime, so the number of diagnoses can be greater than the number of people affected. Cases are allocated to a jurisdiction and region based on where they were diagnosed with ARF.
It is likely that ARF notifications are under-reported to RHD registers in all jurisdictions. A report from Agenson et al. (2020) suggests that many cases of patients who attend the hospital for ARF or RHD are not reported to the jurisdictional registers. Although the registers in each state and territory were functional for the entire analysis period, they were relatively new in some states (Box 1). Clinician awareness and reporting to the registers has likely increased in the years since register commencement, and may also have been affected by the addition of ARF and RHD to the list of notifiable diseases at different times in the various jurisdictions. However, under-diagnosis and under-reporting to the register also means some individuals are not captured in this analysis. It is difficult to determine whether increases in the number of notifications reflect a real increase in the number of cases occurring, improved detection and diagnosis of cases, increases in the number of people being recorded on the registers, or a combination of these.
Box 1: Acute rheumatic fever/rheumatic heart disease registers
All jurisdictions with RHD registers have different notification and data collection practices and therefore the numbers, data quality and completeness in the RHD registers are variable. Table 1 summarises the timeline of program and register establishment across the jurisdictions.
Refer to RHD control programs and registers for more information.
Table 1: Timeline of program and register establishment
|
|
NSW
|
SA
|
WA
|
Qld
|
NT
|
Vic, Tas, ACT
|
|
RHD control program
|
2015
|
2010
|
2009
|
2009
|
1997(a)
|
–
|
|
ARF/RHD register
|
2016
|
2012
|
2009
|
2006
|
1997
|
–
|
|
Definite ARF notifiable
|
2015
|
2016
|
2007
|
1999
|
1996
|
–
|
|
Probable ARF notifiable
|
2015
|
2016
|
2015
|
–
|
2019
|
–
|
|
Possible ARF notifiable
|
–
|
2016
|
2015
|
–
|
–
|
–
|
|
Confirmed RHD notifiable
|
2015(b)
|
2016
|
2015
|
2018(c)
|
2019
|
–
|
|
Borderline RHD notifiable
|
–
|
2016
|
2015
|
2018
|
–
|
–
|
- The Top End Control Program was established in Darwin in 1997, and expanded in 2000 to include the whole Northern Territory.
- In NSW, RHD is only notifiable in persons aged less than 35 years.
- In Qld, RHD only became a notifiable condition on the 01/09/2018.
Source: RHD Australia (ARF/RHD writing group) 2020.