Reducing rheumatic fever

Following a decrease between years 2011 to 2016, there was a stabilisation in the rate of Māori admitted to hospital for the first time with rheumatic fever between 2016 and 2020. Since 2020, Māori rates have decreased from 8.7 per 100,000 (74 cases) in 2020 to 5.5 per 100,000 (49 cases) in 2022 (5.5 per 100,000). This represents an approximately 34% decrease in cases since 2020. However there has been an increase in rates to 8.0 per 100,000 (76 cases) in the year 2023/24.

Hospitalisations for Pacific people fluctuated between 2011 and 2019, however there has been a large decrease in Pacific people admitted to hospital for the first time with rheumatic fever since 2020. Since 2020, Pacific rates have decreased from 19.5 per 100,000 (69 cases) in 2020 to 8.2 per 100,000 (30 cases) in 2022. This represents an approximately 57% decrease in cases since 2020. This decrease has been largely driven by a reduction in hospitalisations for Pacific people in Counties Manukau. However, there has been an increase in rates to 28.1 per 100,000 (94 cases) in the year ending 30 June 2023/24.

An insights report was completed in 2024, which provided analysis of rheumatic fever and rheumatic heart disease through the COVID-19 pandemic in New Zealand. This work was led by Tōmaiora, researchers from the University of Auckland. Key findings included significant decreases in crude acute rheumatic fever hospitalisation rates in 2021-2022, however marked inequities still persisted for Māori and Pacific peoples. The COVID-19 elimination-suppression strategy had a significant independent effect in a best fit model, associated with a reduction in acute rheumatic fever hospitalisations by 50%.

It is not surprising to see an increase in rheumatic fever hospitalisations, given what has occurred with other childhood respiratory infections (viral, invasive pneumococcal disease etc.) during the pandemic, with infection rates initially falling then now rising again. Health New Zealand will continue to watch the situation closely.

It is also important to note that while Aotearoa has a high incidence of rheumatic fever, the annual numbers are small. . Therefore, changes year-to-year may be real, or they may be an artifact of the variability that is seen when there are small numbers of cases.

The following table shows the numbers and rates of people being admitted to hospital with rheumatic fever for the first time in 2023/24 by age group. It shows that the majority of cases continue to occur in children between 5 and 14 years.