Primary prevention of rheumatic fever in the 21st century: evaluation of a national programme.

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dc.contributor.author Jack, Susan J en
dc.contributor.author Williamson, Deborah A en
dc.contributor.author Galloway, Yvonne en
dc.contributor.author Pierse, Nevil en
dc.contributor.author Zhang, Jane en
dc.contributor.author Oliver, Jane en
dc.contributor.author Milne, Richard en
dc.contributor.author Mackereth, Graham en
dc.contributor.author Jackson, Catherine M en
dc.contributor.author Steer, Andrew C en
dc.contributor.author Carapetis, Jonathan R en
dc.contributor.author Baker, Michael G en
dc.date.accessioned 2019-11-25T01:34:49Z en
dc.date.issued 2018-10 en
dc.identifier.citation International journal of epidemiology 47(5):1585-1593 Oct 2018 en
dc.identifier.issn 0300-5771 en
dc.identifier.uri http://hdl.handle.net/2292/49158 en
dc.description.abstract Background:Acute rheumatic fever (ARF) has largely disappeared from high-income countries. However, in New Zealand (NZ) rates remain high in indigenous (Māori) and Pacific populations. In 2011, NZ launched an intensive and unparalleled primary Rheumatic Fever Prevention Programme (RFPP). We evaluated the impact of the school-based sore throat service component of the RFPP. Methods:The evaluation used national trends of all-age first episode ARF hospitalisation rates before (2009-11) and after (2012-16) implementation of the RFPP. A retrospective cohort study compared first-episode ARF incidence during time-not-exposed (23 093 207 person-days) and time-exposed (68 465 350 person-days) with a school-based sore throat service among children aged 5-12 years from 2012 to 2016. Results:Following implementation of the RFPP, the national ARF incidence rate declined by 28% from 4.0 per 100 000 [95% confidence interval (CI) 3.5-4.6] at baseline (2009-11) to 2.9 per 100 000 by 2016 (95% CI 2.4-3.4, P <0.01). The school-based sore throat service effectiveness overall was 23% [95% CI -6%-44%; rate ratio (RR) 0.77, 95% CI 0.56-1.06]. Effectiveness was greater in one high-risk region with high coverage (46%, 95% CI 16%-66%; RR 0.54, 95% CI 0.34-0.84). Conclusions:Population-based primary prevention of ARF through sore throat management may be effective in well-resourced settings like NZ where high-risk populations are geographically concentrated. Where high-risk populations are dispersed, a school-based primary prevention approach appears ineffective and is expensive. en
dc.format.medium Print en
dc.language eng en
dc.relation.ispartofseries International journal of epidemiology en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Humans en
dc.subject Rheumatic Fever en
dc.subject Pharyngitis en
dc.subject Hospitalization en
dc.subject Incidence en
dc.subject Risk Factors en
dc.subject Retrospective Studies en
dc.subject Primary Prevention en
dc.subject Adolescent en
dc.subject Child en
dc.subject Child, Preschool en
dc.subject School Health Services en
dc.subject New Zealand en
dc.subject Female en
dc.subject Male en
dc.subject Young Adult en
dc.title Primary prevention of rheumatic fever in the 21st century: evaluation of a national programme. en
dc.type Journal Article en
dc.identifier.doi 10.1093/ije/dyy150 en
pubs.issue 5 en
pubs.begin-page 1585 en
pubs.volume 47 en
dc.rights.holder Copyright: The authors en
pubs.end-page 1593 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Journal Article en
pubs.elements-id 756532 en
dc.identifier.eissn 1464-3685 en
pubs.record-created-at-source-date 2018-07-31 en
pubs.dimensions-id 30060070 en


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