Frequently Asked Questions

Rheumatic Fever  

• What causes rheumatic fever?
• What are the symptoms of rheumatic fever?
• Will these symptoms go away?
• What groups are most at risk?
• Is rheumatic fever transmitted from person-to-person?
• How is rheumatic fever treated?
• What happens after the patient gets better from rheumatic fever?
• How can Rheumatic Fever be prevented?
• How do I know if my child’s sore throat is Strep A or just a virus?
• Can you get Strep A more than once?
• What are the chances of a child getting a second attack of rheumatic fever?
• If someone gets rheumatic fever more than once, are they more at risk of heart damage?

What is rheumatic fever?
Rheumatic fever is a serious illness that can start after a sore throat (a Group A streptococcal or “strep” infection). A few weeks after the ‘Strep’ throat, your child may develop sore or swollen joints (knees, elbows, ankles and wrists), a skin rash, a fever, stomach pain and/or jerky movements. The first episode of rheumatic fever can also cause permanent damage to the heart valves – this is called rheumatic heart disease.

What causes rheumatic fever?
Rheumatic fever is caused by the body’s reaction to a bacterial throat infection due to streptococcus A. Some people are more likely to have this reaction than others, and Māori and Pacific children and young people are particularly at risk in Northland. 15-25% of sore throats are caused by the Strep A bug, and if they are successfully treated with antibiotics, rheumatic fever can be prevented.

What are the symptoms of rheumatic fever?
Symptoms of rheumatic fever include sore or swollen joints (knees, elbows, ankles and wrists), a skin rash, a fever, stomach pain and/or jerky movements. If the heart valves have been damaged and the child has rheumatic heart disease, they may also experience breathlessness and tiredness.

Will these symptoms go away?
Most of the symptoms go away in time, but damage to the heart valves can be permanent if the child has rheumatic heart disease. In that case, they will need special care when visiting the dentist or dental nurse and may need surgery to repair the damaged valve.

What groups are most at risk?
Māori and Pacific children and young people, particularly those aged between 4 and 19 years, are at highest risk. Poor housing conditions and overcrowding also increase the risk of rheumatic fever.

Is rheumatic fever transmitted from person-to-person?
You can’t catch rheumatic fever from another person, but ‘strep’ throat can be passed onto others by sharing spit, sneezing or coughing.

How is rheumatic fever treated?
The symptoms of rheumatic fever can be treated, but there is no treatment for the illness itself. Usually, a ten-day course of penicillin is given to eradicate the Strep bug. If the heart is damaged, the patient may need to rest and reduce physical activity for some time. The person will also need ongoing monthly injections of penicillin (see below) for at least ten years, to reduce the risk of another Strep infection.

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What happens after the patient gets better from rheumatic fever?
Most of the acute symptoms, such as sore or swollen joints (knees, elbows, ankles and wrists), skin rash, a fever, stomach pain and jerky movements, go away in time. However, damage to the heart valves - rheumatic heart disease - can be permanent.

The patient will need monthly injections of antibiotics (provided free in Northland by a public health nurse) for a minimum of ten years, or sometimes longer, as the doctor determines. This is to reduce the risk of Strep infection and further attacks of rheumatic fever, which could cause more heart damage.

Extra care must be taken when obtaining dental treatment because this can potentially cause further infections affecting the heart valves.
Your child will need extra antibiotics by mouth before some types of dental treatment to avoid infection of the heart valves.
You need to help your child to look after their teeth and avoid any infection. Make sure that they:

• brush their teeth twice a day with fluoride toothpaste
• don't have sweet food and drinks too often
• have dental checks every six months.

How can Rheumatic Fever be prevented?
Rheumatic fever can be prevented! When your child has a sore throat, take them to the doctor or medical clinic to have it checked out. Ask the doctor or nurse to do a throat swab. If antibiotics are prescribed, make sure that the child takes the full course of medicine.

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How do I know if my child’s sore throat is Strep A or just a virus?
You can’t tell by looking at the throat whether a sore throat is caused by a virus or the Strep A bug. It is really important that all sore throats are checked by a medical professional and that a throat swab is taken. In some cases, a doctor or nurse will prescribe antibiotics immediately if they think your child is at high risk for rheumatic fever, just to make sure. The important thing is to get your child seen by a doctor or nurse as soon as possible.

Can you get Strep A more than once?
Yes, definitely, so you need to remain vigilant about sore throats. The antibiotics given for one occurrence of a sore throat do not provide protection into the future from Strep A infections.

What are the chances of a child getting a second attack of rheumatic fever?
Rheumatic fever can occur again if your child has another infection with the Strep A bug which goes untreated. The best way to stop your child having another attack of rheumatic fever is to make sure they have regular Penicillin injections - on time.  Penicillin injections:

• must be given every 28 days
• are deep intramuscular injections  
• are painful - but very important to reduce the risk of heart damage.

They are given by your Public Health Nurse, who will come to your home or your child’s school and give the injection.

Your child will need monthly injections of antibiotics (provided free by a public health nurse in Northland) for a minimum of ten years, or sometimes longer, as the doctor determines. This may seem like a long time, but if your child doesn’t have these injections, they could have another rheumatic fever attack and get severe heart damage. Your doctor will tell you when it is safe for your child to stop having the Penicillin injections.

If someone gets rheumatic fever more than once, are they more at risk of heart damage?
Each attack of rheumatic fever has the potential to damage the heart. But with proper care and regular Penicillin injections, most children with rheumatic fever lead a normal life.