In the year to last June, 112 people were admitted to hospital with a first episode of rheumatic fever. The disease is associated with poverty and overcrowded housing and the incidence is far higher in New Zealand's Maori and Pacific populations than in other ethnicities.
In papers obtained this year under the Official Information Act, the Ministry of Health's director of protection, regulation and assurance, Dr Stewart Jessamine, told Health Minister Jonathan Coleman: "Meeting the two-thirds reduction in 2017 will be challenging."
The research found that some people with a sore throat gave up on trying to get an appointment at a general practice after being told they would have to wait two or three days.
"However, the rates for the last three financial years ... show an overall decreasing trend. This can also be seen when comparing trends across the last three calendar years ...
"These downward trends suggest that [it] is possible that the target may be met in a further 12-24 months."
The Herald sought the papers in November, after the ministry revealed that, of the 11 district health boards involved in the Rheumatic Fever Prevention Programme because of their high rates of the illness, only four - Northland, Tairawhiti, Hawke's Bay and Hutt Valley, had met the interim target at June 2016. Waikato was later said to have met the target after data corrections.
Counties Manukau, Lakes, Bay of Plenty and Capital and Coast partially achieved; and Auckland and Waitemata, whose rates had actually increased, fell outside the interim target.
Key and Prime Minister Bill English have described the Better Public Services programme as a key priority for the Government.
Health Minister Jonathan Coleman said: "The Better Public Service targets cover areas where previous Governments have struggled to make progress. We've always known they're ambitious targets. We're making good progress to reduce rheumatic fever rates, but there's still more work to be done."
DHBs have implemented the programme with variations. It generally involves school clinics in high-risk areas at which children with a sore throat have it swabbed and are given antibiotics if the test is positive for group-A strep. There are also several hundred free sore-throat clinics for high-needs groups at general practices, pharmacies, after-hours clinics and pathology laboratories.
The ministry papers say, following research interviews with some affected parents, young people and health providers in Counties Manukau, Hutt Valley, Waikato and Tairawhiti, that many aspects of the non-school clinics did not align with the ministry's intentions.
"They were not rapid, drop-in, convenient or attractive to whanau and youth. There were, however, examples of services that did align and were attractive to priority populations."
The research found that some people with a sore throat gave up on trying to get an appointment at a general practice after being told they would have to wait two or three days.
Jessamine said the research led DHBs to make changes to their rheumatic fever plans.
"For example, Waikato implemented sore throat clinics widely, with a focus on both primary health organisations and community engagement."
He said a ring-fenced fund of $5 million a year from July until 2022 was being allocated to ensure the 11 DHBs continued rheumatic fever prevention work in high-needs groups.
The Auckland and Waitemata DHBs said their revised plans included greater efforts to raise rheumatic fever awareness in Pacific communities and extending the reach of the Healthy Housing initiative.
Waikato DHB's executive director of community and clinical support, Mark Spittal, said its rate of rheumatic fever for 2016 was 1.3 per 100,000, putting it on track to meet its target for the 2017 June year of 1.2.
He credited this to having throat swabbing at general practices, pharmacies, laboratories and low-decile high schools, plus swabbing and awareness-raising by Maori and Pacific health providers.
A public health physician at Counties Manukau DHB, Dr Pip Anderson, said it had focused on the school-based programme, leading to a significant reduction in rheumatic fever in the 5 to 12 age group.
It had also funded nurse-led rapid sore throat management in primary care, but acknowledged issues with access to non-school sore throat services.
Hutt Valley DHB's general manager of strategy, planning and outcomes, Helene Carbonato, said it was now working closely with marae, strengthening connections with Pacific health providers and increasing the number of rapid-response providers in pharmacies and general practices.
Labour's health spokeswoman, Annette King, said, "The key issues, particularly in South Auckland, are the housing issues and they haven't been resolved.
"We know one of the greatest contributors is poor housing and overcrowding. As long as that exists, it's like pushing water uphill."
Rheumatic Fever Target
District Health Board performance, and target, in 2015/16
Achieved
Hawkes Bay
Actual 1.9 Target 2
Hutt Valley
Actual 2.1 Target 2.2
Northland
Actual 1.2 Target 4.7
Tairawhiti
Actual 2.1 Target 3.8
Waikato
Actual 1.5 Target 1.6
Wairarapa
Actual 0 Target 0
Whanganui
Actual 0 Target 1.4
Partially achieved
Bay of Plenty
Actual 2.7 Target 1.7
Capital and Coast
Actual 2 Target 1.4
Counties Manukau
Actual 7.1 Target 6.1
Lakes
Actual 4.8 Target 3.5
MidCentral
Actual 1.2 Target 0.8
Not achieved
Auckland
Actual 3.9 Target 1.5
Waitemata
Actual 2.1 Target 1
South Island region
Actual 0.6 Target 0.2
Taranaki
Actual 1.7 Target 0.4
Notes
• Rates are number of cases per 100,000 population of people admitted to hospital newly diagnosed with rheumatic fever.
• Wairarapa, Whanganui, MidCentral, Taranaki and the South Island DHBs are not part of the Rheumatic Fever Prevention Programme.
A rheumatic fever survivor
Former professional rugby league player Awen Guttenbeil spent months in hospital after he was diagnosed with rheumatic fever.
Now 40, the former Kiwis and Warriors player regrets that at 9, he concealed a sore throat from his parents because he didn't want to miss out on playing sports. His illness got much worse.
"I remember clearly the morning I woke up and couldn't walk," Guttenbeil has written in the Herald.
"I couldn't move my joints and I was in a whole lot of pain. I remember dragging myself out of bed and pulling myself up the hallway trying to stand myself up against the wall and leaning against it to stay upright.
"I called out to Mum to come and help me ...," he says in a video to encourage people to get a sore throat checked.
"They took me up to Whangarei Hospital and they diagnosed me with rheumatic fever. Pretty scary when you knew that it was something to do with your heart."
"I was put on a course of penicillin injections for 10 years. Monthly injections. It took me about two years before I got back to doing the things that I was before I became sick."
He reckons that if he had told his parents about his sore throat straight away, he might have avoided rheumatic fever.
"If you know your child is not well and has a sore throat, you've got to get it checked."
Mangere mum Sitela Vete remembers her shock at discovering her 11-year-old son Talia'uli's sort throat had morphed into rheumatic fever, causing heart valve damage.
"I was lost for words, I was crying," she said.
"It was the worst feeling every, that time when they said that there's a valve leaking in his heart.
"I was shocked, to be honest, because it never comes to my understand that minor things like that can cause so much damage to the kids."
Talia'uli said he was running in a race at a school athletics day when he began to feel breathless, tired and dizzy, and fell behind. It was unusual for the sporty student, who had dreams of becoming an All Black.
Now 14, Talia'uli said he remembered being surprised at his diagnosis, and at being told he couldn't play sports until he was better.
It took about a month before the doctor would allow him to get back into sports, but Talia'uli must still take monthly injections until he is 21.
Sitela Vete said she had no idea a simple sore throat could lead to rheumatic fever, and had thought nothing of Talia'uli's sore throat. Now whenever her children get sick she takes them straight to the doctor.
One of her other sons recently picked up a sore throat after a family trip to Tonga, and tests came back positive for the bacteria that causes the fever. He is now on antibiotics.
Vete urged other parents to keep an eye on their children, make sure they brush their teeth at night, and take them straight to the doctor if they get sick.
