Victoria Takes a Major Step in Public Health – Notifiable Conditions ARF and RHD

Published on August 1, 2023

Victoria, Australia – In a significant move to bolster public health efforts and protect vulnerable communities, the state of Victoria has officially declared acute rheumatic fever (ARF) and rheumatic heart disease (RHD) as notifiable conditions. This means that medical practitioners are now mandated to report suspected or confirmed cases of ARF and RHD to the Victorian Department of Health within five business days of diagnosis.

The decision to classify ARF and RHD as notifiable conditions comes under the umbrella of the Public Health and Wellbeing Act 2008, a crucial legislation aimed at monitoring and controlling infectious diseases and specific health conditions. By making these conditions notifiable, authorities can gather comprehensive and accurate data, enabling a more robust public health response and safeguarding the well-being of the community.

ARF primarily affects children but can also occur in individuals of various age groups, following an infection with the Group A Streptococcus (GAS) bacterium, commonly known as Streptococcus pyogenes. If left untreated, GAS pharyngitis, also known as ‘strep throat,’ can escalate into ARF, leading to inflammation in the joints, heart, skin, and central nervous system. Early intervention is crucial, and individuals with ARF are recommended to begin regular antibiotic treatment, known as ‘secondary prophylaxis,’ to prevent further GAS infections and reduce the risk of disease progression.

RHD, on the other hand, develops after one or more episodes of ARF during childhood or adolescence. However, it can also manifest following subclinical or unrecognized ARF. Patients with RHD suffer from chronic valvular heart disease, with early stages being asymptomatic. However, as the disease progresses, individuals may experience various symptoms, ultimately culminating in heart failure. For those affected, cardiac surgery to repair or replace heart valves might become necessary. Pregnant individuals with RHD are at heightened risk of complications, making early diagnosis and management crucial.

Inequities in health outcomes have been observed, with ARF and RHD disproportionately affecting certain populations in Victoria. Communities such as Aboriginal and Torres Strait Islander people and Pacific Islanders have been hit harder, leading to chronic complications and disparities in health. Additionally, immigrants from developing countries, including refugees and asylum seekers, are also at increased risk. A personal or family history of ARF or RHD further elevates the risk of developing these conditions.

To diagnose ARF, healthcare providers rely on clinical features, pre-existing risk factors, and laboratory evidence of a preceding GAS infection, following the Revised Jones Criteria. For RHD, echocardiographic findings interpreted by a cardiologist form the basis of diagnosis. Healthcare professionals can find detailed guidance on prevention, diagnosis, and management in The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022).

Authorities emphasize that early detection and notification are crucial in combatting these conditions effectively. Medical practitioners must promptly notify the Victorian Department of Health if they reasonably suspect or confirm ARF or RHD cases. This can be done using the Communicable Diseases online notification tool or by completing the ARF/RHD notification form and returning it via post or fax. Additional information on the notification process and downloadable forms can be found on the Department of Health website.

Victoria’s commitment to addressing ARF and RHD as notifiable conditions reflects the state’s dedication to improving public health outcomes and reducing health disparities in vulnerable populations. By acting swiftly and collaboratively, health professionals and authorities can ensure a safer and healthier future for all citizens.

For more information, visit the Department of Health website or refer to The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease (3.2 edition, March 2022).