It was great to hear the announcement a couple of days ago by the Prime Minister’s of New Zealand and Australia, John Key & Julia Gillard, of $3 million of joint funding to support the testing of three potential vaccine candidates for Rheumatic Fever.
Rheumatic Fever is a complication of infection with the bacterium Streptococcus pyogenes, also known as Group A Streptococcus (GAS). Many people carry this bacterium in their throats without showing any symptoms – about 1 in 100 adults and more than 1 in 10 children.
S. pyogenes causes a wide range of human diseases, ranging from tonsillitis (‘strep throat’) and superficial skin infections (impetigo) to more severe life-threatening diseases such as puerperal sepsis (‘childbed fever’), necrotising fasciitis (literally ‘flesh-eating’) and multiple organ failure through over-stimulation of the immune system (toxic shock syndrome). In fact, S. pyogenes earns a place in the ‘top ten’ most lethal infectious microbes, responsible for over half a million deaths per year. Despite the importance of this bacterium there is no licensed vaccine, hence the announcement.
Rheumatic Fever is thought to be caused by the production of antibodies towards S. pyogenes which cross react with the heart, joints, skin and brain, making them become inflamed and swollen. Damage to the heart valves can lead to Rheumatic Heart Disease which may require surgery to replace the inflamed valves. To try to prevent this, those who have had Rheumatic Fever are given monthly injections of penicillin – for 10 years!
Children between the ages of 5 and 14 are particularly affected by Rheumatic Fever, and Maori and Pacific children have 20 to 40 times higher rates of the disease than other Kiwis. The same is true in Australia, where Aboriginals have rates that are 25 times higher than other Australians. These differences may well have a genetic component, but as with many other infectious diseases, poverty and household crowding play a big role.
But even though a vaccine is still many years away,* both Rheumatic Fever and Rheumatic Heart Disease can be prevented, by giving people with a ‘strep throat’ the antibiotic penicillin as early as possible. Fortunately, S. pyogenes is still very sensitive to penicillin. Last year the NZ Ministry of Health announced its Rheumatic Fever Prevention Programme, which has health care workers going in to schools and swabbing kids to try to detect S. pyogenes and treat infections early on. Hopefully these measures will soon start to pay off, with better health outcomes for Kiwis and less burden placed on our healthcare system.
*And solving poverty and income inequalities even further…..