Acute rheumatic fever and rheumatic heart disease in Australia

At 31 December 2024, there were 11,794 people living with rheumatic heart disease (RHD) and/or a history of acute rheumatic fever (ARF) recorded on the registers in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory, or notified in Victoria. Of these, 3,848 people (33%) had only ARF recorded, 3,885 people (33%) had only RHD recorded, and 4,061 people (34%) had both ARF and RHD recorded. Four-fifths (9,496; 81%) of people recorded on the jurisdictional registers were Aboriginal and Torres Strait Islander (First Nations) people.

Acute rheumatic fever

In 2024:

• 506 diagnoses of ARF were recorded in 501 people in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory in 2024 (2.7 per 100,000 population)
• About 29% of ARF diagnoses were recurrent cases  
• First Nations people accounted for 93% (472) of the diagnoses (51.8 per 100,000 population)
• ARF was more common among First Nations females (277 cases; 61.0 per 100,000) than males (195 cases; 42.7 per 100,000)
• the highest rate was among First Nations people aged 5–14 (211 diagnoses; 110.8 per 100,000). The median age at diagnosis among First Nations people was 16.5 years.

The rate of diagnoses among First Nations people decreased from 54.2 per 100,000 in 2016 to 51.8 per 100,000 in 2024 (this change was not statistically significant).

Rheumatic heart disease

Prevalence

At 31 December 2024, 7,510 Australians (71.1 per 100,000) living with RHD were recorded on the jurisdictional registers in Queensland, Western Australia, South Australia and the Northern Territory. Of these:

• around 28% (2,071) were aged under 25
• close to 66% (4,939) were females
• among all Australians, the highest prevalence rate was in the Northern Territory (1,072 per 100,000) and the greatest number was in Queensland (3,249 people)
• about 4 in 5 diagnoses (5,867; 78%) were First Nations people
• the median age among First Nations people with RHD (33.5 years) was considerably younger than for non-Indigenous Australians (61.4 years).

Incidence

In 2024 in Queensland, Western Australia, South Australia and the Northern Territory:

• there were 410 Australians who had newly diagnosed RHD
• 299 new RHD diagnoses among First Nations people were reported (54.1 per 100,000 population)
• new RHD diagnoses were more common among First Nations females than males (68.3 and 40.1 diagnoses per 100,000, respectively)
• 58% of new diagnoses in First Nations people were in people aged under 25 (173 diagnoses)
• the greatest number and highest rate of new diagnoses among First Nations people was in the Northern Territory (141; 180.2 per 100,000).

The number and rate of RHD diagnoses among First Nations people increased from a low of 245 (50.9 per 100,000) in 2016 to 299 (54.1 per 100,000) in 2024. RHD incidence decreased significantly from 2018 to 2024.

Heart surgery for rheumatic heart disease

In 2024 in Queensland, Western Australia, South Australia and the Northern Territory, 146 people underwent 150 surgical events for RHD. Most of these (111 people; 76%) were First Nations people.

Rheumatic heart disease in New South Wales

At 31 December 2024, there were 147 people living with RHD recorded on the register in New South Wales. In 2024, 4 Australians were newly diagnosed with RHD, with a total of 4 surgical events recorded in the New South Wales register.

Delivery of secondary prophylaxis to First Nations people

Secondary prophylaxis refers to the prescribing of an antibiotic to reduce repeat episodes of ARF due to recurrent group A streptococcus (Strep A) infections. The most common antibiotic formulation prescribed for Aboriginal and Torres Strait Islander peoples with RHD and/or a history of ARF is intramuscular benzathine benzylpenicillin, also known as benzathine penicillin G (BPG), typically required every 28 days (13 times per year). In some cases, it is required every 21 days (17 times per year). Oral formulations are also permitted in certain circumstances as are other antibiotic classes if allergies are present.

Receiving less than 40% of scheduled secondary prophylaxis is equivalent to receiving no prophylaxis at all in terms of reducing recurrent acute rheumatic fever (ARF) episodes, and receiving at least 80% of doses is considered to provide adequate protection against recurrent ARF (deDassel et al 2018).

Proportion receiving benzathine benzylpenicillin G as prescribed

In 2024, among First Nations people in Queensland, Western Australia, South Australia and the Northern Territory prescribed 3- or 4-weekly BPG:

• 32.4% (1,712 people) received 80% or more of their prescribed doses
• 34.2% (1,806) received 40% to 79% of their prescribed doses
• 33.4% (1,764) received less than 40% of their prescribed doses.

In New South Wales, information on BPG is only provided to the AIHW for patients who provide consent. In 2024, among First Nations people in New South Wales for whom information on BPG was available, 10% (5 people) received at least 80% of their prescribed doses. 

ARF recurrence rate among people on benzathine benzylpenicillin G

In 2024, among 5,318 First Nations people who had ARF or RHD and were prescribed BPG in Queensland, Western Australia, South Australia and the Northern Territory, there were 138 ARF recurrences at a rate of 2.8 recurrences per 100 patient-years.