Rheumatic Rever resources

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Rheumatic Fever resources for Health Professionals

Sore throat rapid response services in the Waikato - Waikato District Health Board is working with communities to provide free sore throat rapid response services to eligible children and their households across the Waikato, to identify and treat Group A Streptococcal (GAS) throat infections and prevent rheumatic fever and heart damage. 

Contracted GP practices are providing free drop in services for both enrolled and non-enrolled eligible patients.  Secondary school based health clinics, out of hours medical centres and selected pharmacies and Pathlab sites are also providing services.

Eligibility criteria for the free sore throat rapid response service:

  • Must have a sore throat
  • Must be 4 – 19 years of age
  • Must either be: 
    • Maori or Pacific Island child OR
    • Non-Maori, non-Pacific child living in an NZdep quintile five area

Note: If an eligible child has a positive GAS result any symptomatic household members aged 3 – 35 years also become eligible for free throat swabbing and treatment

Alternatively, in a GP practice, the patient’s address can be entered into Medtech, and an NZDep rating will be generated.  If the patient is NZDep 9 or 10, they are eligible to receive free swabbing and treatment.

If patients are not eligible, they can still be swabbed and treated at their cost.  If they are not eligible, they are not considered at risk to develop rheumatic fever.   

First-line treatment

Amoxicillin orally for 10 days

  • Children < 30 kg: 750 mg once daily
  • Children ≥ 30 kg: 1000 mg once daily

Benzathine penicillin G (BPG), intramuscular, single dose

  • Children < 30 kg: 450 mg (600,000 units)
  • Children ≥ 30 kg: 900 mg (1,200,000 units) 

Definite or possible anaphylaxis to penicillin or amoxicillin:
Erythromycin ethyl succinate orally for 10 days

  • Children and adults: 40 mg/kg/day in 2–3 divided doses
  • Maximum adult daily dose 1000 mg

These antibiotics can be obtained and supplied for free under routine MPSO processes.

Link to full document on Ministry of Health website

Amoxicillin and penicillin are equally effective in eradication of Group A Streptococcus (GAS).  Amoxicillin is given once daily (rather than twice daily for penicillin).  This assists with adherence, completion of the course of antibiotics and effective eradication of GAS. 

Can amoxicillin be given when glandular fever/Epstein Barr Virus (EBV) is also suspected – particularly amongst the adolescent population?

Both Medsafe and the NZ Formulary state that a maculopapular rash can occur when amoxicillin is given when EBV is present.  But as confirmed by the Ministry of Health’s clinical advisor for rheumatic fever, the rash is a minor complication and does not warrant changing to penicillin as first line treatment, even in an adolescent population when EBV may also be suspected.

Thus, the recommendation still stands that once daily amoxicillin is first line treatment for GAS, with erythromycin for those with known anaphylactic allergy to beta-lactam antibiotics.

Although swabs can remain at room temperature for up to 72 hours, prompt processing is required to detect and treat Group A streptococcal throat infections, before rheumatic fever develops. 

Laboratory managers have offered the following options to assist in improving laboratory turn-around time for swabs taken after the final drop off time on Friday, or over the weekend:

Hamilton

Pathlab, Tristram Street (back of Anglesea Clinics)

  • Tristram Street collection room is open Saturday 8am – Noon.  Package swabs with lab forms into individual bags and drop them in any time during these opening hours.
  • Red coloured out of hours collection box – package swabs with lab forms into individual bags and drop in any time.
  • It is cleared on:
    • weekdays at 8pm
    • Saturdays 8am and 1230pm

 

Thames Hospital Laboratory

Drop swabs in to Thames hospital main reception.

  • Package swabs with lab forms into individual bags and drop into the specimen collection basket for processing
  • If laboratory staff are working over the weekend, they can process the swabs.  If they are not, they will be couriered to Waikato Hospital Laboratory for weekend processing

 

Taumarunui Hospital Laboratory

Drop swabs in to Taumarunui hospital ward reception.

  • Package swabs with lab forms into individual bags and drop into the specimen collection basket for processing.
  • If laboratory staff are working over the weekend, they can process the swabs.  If they are not, they can process the swabs first thing Monday morning.

 

Te Kuiti and Tokoroa Hospital Laboratories

Either

  • take to Hamilton (if someone is going that way) and drop into the Waikato Hospital laboratory – they process swabs throughout the weekend
  • drop into local hospital laboratory for processing first thing Monday morning.

The name of the doctor aligned with the service that the patient presented to should be on the lab form.  This ensures the result comes to the right service for prompt follow up.

GP practices/accident and medical centres/school based clinics

  • if a patient presents to any of these services and are either swabbed onsite, or referred to Pathlab to have their throat swabbed, the service should use their form with their GP name on it only.   

Midlands Community Pharmacy Group (MidCPG) swabbing programme

  • This includes the pharmacies, Pathlab sites and nursing staff at K’aute Pasifika Services and Asthma Waikato.
  •  If a patient drops into any of the services run under MidCPG, the MidCPG lab form is to be used, and the MidCPG patient data form is to be completed and faxed immediately to MidCPG.

 

All patients swabbed and treated under the MidCPG programme who have a POSITIVE GAS result will have a summary of their result and treatment details faxed to their GP.

Please ensure that each GP practice has internal processes for entry of this data onto their systems.  It is important that this data is held so a record can be kept of the frequency of GAS episodes and the treatment that patients receive. 

One of a few known risk factors for rheumatic fever is crowded living conditions.  GAS, the bacteria that can go on to cause rheumatic fever and damage to the heart, is a droplet spread bacteria that can be passed on from person to person when coughing and sneezing. 

Logically, the more people living in close contact within a household, the more that GAS can spread from person to person – particularly if people are sharing beds or bedrooms to keep warm, or to accommodate a larger family/whanau within the house. 

Waikato District Health Board’s Maori Health Unit (Te Puna Oranga) is managing a healthy housing initiative called Whare Ora.  If children are considered high risk – ie - have been hospitalised for respiratory tract infections; OR have rheumatic fever; OR there have been three positive GAS throat infections in the same household in the past three months, AND are living in crowded homes, they may be eligible for a healthy homes assessment and provision of support and resources to make their home warmer and healthier.  If in doubt refer.

Further information on eligibility and how to refer families can be found on this link:

www.waikatodhb.health.nz/your-health/wellbeing-in-the-waikato/whare-ora

Pathlab sites, hospital laboratories and GP practices throughout the Waikato region will be used as drop-off points for throat swabbing services.  The services are aware of the pick-up locations, existing pick-up times and opening hours, and will be using these.

Contracted pharmacies have been provided with an initial order of swabbing supplies – including bacterial swabs, laboratory bags, tongue depressors and laboratory forms. 

As the programme continues, they will access more supplies through local laboratory services.  We are recommending that they are mindful of expiration dates of swabbing supplies when picking up supplies from your laboratory, so large numbers of supplies will generally not be requested.

Queries on laboratory involvement in the programme can be forwarded to

Project manager Michelle Morley 07 8382569

Kay Stockman (Hospital Laboratories manager) 021 341 853
Kay.Stockman@waikatodhb.health.nz

Claudio Turilli (Pathlab) on 07 858 0799
Claudio.Turilli@pathlab.co.nz