Rheumatic fever Te kirikā rūmātiki

Strep A bacteria (strep germs) may cause a strep throat infection, which if left untreated can trigger rheumatic fever to develop in some people. 

Rheumatic fever is a type of autoimmune disease which can affect the:

• heart
• skin
• joints
• brain.

An autoimmune disease is a condition where a person’s immune system:

• overreacts to an infection caused by harmful bacteria
• mistakenly damages healthy cells and tissues when trying to fight off harmful bacteria.

This leads to inflammation and various other symptoms. 

It is unclear why some people will have this immune response to a strep throat infection and not others. There is currently no test that can confirm who will develop rheumatic fever and who will not.

Strep A bacteria (strep germs) spread from person to person by:

• breathing in air after a person with a strep throat infection has coughed or sneezed
• touching a person's skin, or surfaces and other objects (such as drink bottles, shared cutlery, bedding) that have been contaminated with an infected person's saliva, snot or skin sore.

Strep germs can also cause skin infections. It is not clear if strep skin infections can cause rheumatic fever. But it is important to get skin infections checked by a healthcare professional so they can be treated if needed. This is to reduce the risk of a skin infection:

• leading to a more serious infection
• contributing to the spread of Strep A within a household, school or childcare facility. 

Skin infections — KidsHealth

The main symptom of a strep throat infection is a sore throat. In young children, signs of a sore throat can include:

• finding it hard to swallow
• having trouble eating or drinking.

The following symptoms of rheumatic fever can then develop 1 to 5 weeks after a person has had a strep throat infection. 

Sore joints

Sore joints is the most common symptom of rheumatic fever. Joints may be red, swollen and feel hot. This often includes the:

• hip
• knees
• elbows
• ankles
• wrists.

Different joints may be sore on different days. Sore joints may cause a limp or difficulty walking due to pain. 

Shortness of breath

You may feel short of breath more easily than usual when you are active or exercising. 

Unusual jerky movements of your hands, feet, tongue and face

Unusual jerky movements can look like fidgeting or being unable to sit still and can affect your handwriting. The movements stop during sleep. 

Over time, most of these symptoms will go away but damage to a person's heart valves, known as rheumatic heart disease, can be permanent.

Preventing strep germs from spreading will help to reduce the chance of a person then developing rheumatic fever. To do this you should:

• cover your mouth and nose when coughing or sneezing, throw away the tissue afterwards, and wash and dry your hands thoroughly with soap and water
• avoid sharing drink bottles, food or cutlery even if you and others are feeling well — people can carry and spread strep germs even if they do not have symptoms such as a sore throat or cough
• avoid preparing food for others while unwell or if you have a skin infection on your hands, if possible. 

As well as these healthy habits, if you are able to you can also reduce the risk of strep infections from spreading by:

• having your household members sleep in separate rooms and beds
• keeping your home warm and dry where possible. 

The Healthy Homes Initiative

The Healthy Homes Initiative helps eligible families make their homes warmer, drier and healthier, to enhance the health and wellbeing of whānau by reducing the risk of germs spreading.

Healthy Homes Initiative

Rheumatic fever can have long-lasting consequences, especially if a person develops rheumatic heart disease. This is a serious disease of the heart caused by rheumatic fever.

During rheumatic fever, the heart valve tissue and sometimes other parts of the heart (the heart lining or muscle) can become:

• swollen
• inflamed
• swollen and inflamed (a condition called carditis).

This can cause scarring. When the heart is damaged in this way, it stops the heart valves from functioning properly. This is called rheumatic heart disease. People with severe damage may need surgery to repair or replace damaged heart valves.

Heart valve damage can remain after other symptoms of rheumatic fever have gone. Early signs of rheumatic heart disease may include:

• unexplained breathlessness
• tiredness
• chest pain or discomfort
• fast or irregular heartbeats.

Other complications of rheumatic heart disease can include:

• infection of damaged heart valves (infective endocarditis)
• heart rhythm problems
• a stroke caused by clots forming in the enlarged heart, or on damaged valves.

Repeated episodes of rheumatic fever can make rheumatic heart disease worse. This is why it is very important to try and prevent recurrences of rheumatic fever from happening.

Preventing recurrences of rheumatic fever

Māori or Pacific people aged 3 to 35 years, particularly tamariki and rangatahi aged between 4 and 19 years, are most at risk of developing rheumatic fever, especially those who:

• have a whānau or family history of rheumatic fever, rheumatic heart disease or both
• live in a large household or crowded house
• experience difficulties accessing primary healthcare. 

If you or your tamariki or rangatahi are in any of these groups you should get a sore throat or skin infection checked every time they occur. A child can get rheumatic fever more than once. 

Māori and Pacific people aged 3 to 35 years should get a sore throat checked by a healthcare provider every time they happen. This can help reduce the chance of developing rheumatic fever.

Where to get a sore throat checked

There are several places you can get a sore throat checked.

You can call or visit your usual GP, doctor or Hauora or healthcare provider. Let them know you or another family member has a sore throat.

Some pharmacies can check sore throats and may provide treatment for tamariki or rangatahi at higher risk of rheumatic fever. 

Pharmacies that offer sore throat checks — Healthpoint

Your child's school may have a free sore throat management programme which can offer:

• access and support with testing
• assessment
• treatment
• referrals.

Contact their school to find out. 

If you are very worried about a person's sore throat or skin infection, you can also call Healthline free anytime, 24/7.

Call Healthline: 0800 611 116

If a person is at higher risk of developing rheumatic fever and has a sore throat which could be strep throat, they will be given antibiotics to treat the infection. A full course of antibiotics is 10 days. It is important they take the full course prescribed to them, even if they start to feel better. This will clear the germs causing the throat infection which will make it much less likely that strep throat will lead to rheumatic fever.

If your or your child have symptoms of rheumatic fever, testing is likely to be needed. There is no single test to diagnose rheumatic fever. The diagnosis is made using a combination of tests which are usually done in the hospital. Test results will confirm whether a person has rheumatic fever or not. Tests may include:

• a blood test
• a throat swab
• an electrocardiogram (also known as an ECG, this records the electrical signal from the heart to check for different heart conditions)
• an echocardiogram (also known as an ultrasound, this records sound waves to show how blood flows through the heart and heart valves).

A person may need to stay in hospital for quite a few days while the tests are completed and the results become available.

If you or your child have rheumatic fever, public health service staff will be notified by a healthcare provider. They will provide you with support and advice. This may include the following recommendations. 

Taking time off school or work 

People can return to their normal activities once public health staff confirm it is safe for them to be around others. 

Not exercising 

Reducing or stopping exercise until your body has recovered.

Immunisations

Having an annual flu vaccine, as well as keeping up to date with all other recommended vaccines. The flu vaccine is free for people who have rheumatic heart disease.

Immunisations are important for people who have had rheumatic fever to prevent other illnesses which can affect heart health, like flu.

Flu (influenza) vaccine

Regular dental checks

Having regular dental checks and taking extra care of teeth and gums. 

• If you or your child has had rheumatic fever before or have rheumatic heart disease now, tell your oral health professional, such as a dentist, dental nurse, hygienist or therapist. 
• Some tamariki and rangatahi may need antibiotics before having dental work done. This is to help reduce the chance of any infection reaching their heart during the dental procedure. 
• Dental care is free for all tamariki and rangatahi up until they turn 18 years.

Dental care

It is important to prevent more episodes of rheumatic fever from happening to reduce the risk of a person developing rheumatic heart disease. To do this it is important to stop further strep throat infections. This requires penicillin antibiotic injections every 28 days for at least 10 years. These injections may be needed into adulthood.