Acute rheumatic fever and rheumatic heart disease in Australia

This section presents information on diagnoses of acute rheumatic fever (ARF) reported to Australian rheumatic heart disease (RHD) control programs until the end of 2024. 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. In this section of the report, cases are allocated to a jurisdiction and region based on where they were diagnosed.

The total number of ARF diagnoses recorded depends on the reporting practices of the various RHD registers. It is likely that ARF diagnoses are under-reported to RHD registers in all jurisdictions. The evidence shows that many cases of patients who attend the hospital for ARF or RHD are not reported to the jurisdictional registers (Agenson et al. 2020; Stacey 2024).

In 2024, 506 diagnoses of ARF were recorded in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory combined. These diagnoses occurred in 501 Australians (Supplementary table 3.1) 

Aboriginal and Torres Strait Islander (First Nations) people accounted for 472 (93%) of the diagnoses from 467 people, with a rate of 52 diagnoses per 100,000 population (Supplementary tables 3.1 and 3.2).

• The rate of ARF among all Australians was 2.7 per 100,000 in both 2016 and 2024, although a slight increase occurred between these years (Figure 3.1; Supplementary table 3.2).
• From 2016 to 2021, rates of ARF among First Nations people increased from 54 to 69 per 100,000 and then decreased to 52 per 100,000 in 2024 (Figure 3.1; Supplementary table 3.2).

Several factors may affect the number of cases reported in the register in each jurisdiction. Increased investment from government and philanthropic organisations may enhance clinician and community awareness, particularly in high-risk Aboriginal and Torres Strait Islander populations. Clinician awareness and case reporting to the registers have also likely increased since the registers were established and may have been further influenced by the addition of ARF and RHD to the list of notifiable diseases at different times across jurisdictions. It is difficult to determine whether increases in the number of notifications reflect a true rise in the number of cases, improved detection and diagnosis, greater recording of cases due to changes in notification legislation, or a combination of these factors.

The majority of ARF diagnoses are in children and young adults

Of the 506 ARF diagnoses among all Australians in 2024:

• the most common age at diagnosis was 5–14 years (229 or 45%)
• females accounted for 58% of diagnoses
• in people aged under 15 years, ARF rates were similar among boys and girls, but among those 15 years and over women had a higher rate than men (Figures 3.2a and 3.2b; Supplementary table 3.3b).

Of the 472 ARF diagnoses among First Nations people in 2024:

• the highest rate of diagnosis was among those aged 5–14 years, accounting for about 45% (211) of all diagnoses
• females accounted for 59% (277) of diagnoses
• ARF rates per 100,000 population among females were higher than those among males, except in those aged 0–4 years (Figures 3.2a and 3.2b; Supplementary table 3.3a).

Diagnoses of acute rheumatic fever are more common in Remote and very remote areas

In 2024, the rate of acute rheumatic fever (ARF) diagnoses among First Nations people increased as remoteness increased (Figure 3.3; Supplementary table 3.5)

In 2024, the Northern Territory had the highest rate of diagnoses per 100,000 population (386 diagnoses per 100,000 First Nations people and 117 per 100,000 for all Australians) and New South Wales had the lowest rate (less than 1 diagnosis per 100,000 for First Nations people and all Australians (Figure 3.4; Supplementary tables 3.4a and 3.4b). The diagnosis rates in the other four jurisdictions were much lower compared to those in the Northern Territory.