Te kirikā rūmātiki Rheumatic fever

Rheumatic fever is a serious but potentially preventable illness that often starts with a sore throat or a skin infection. Without treatment, these can cause rheumatic fever. Rheumatic fever can damage your heart — this is called rheumatic heart disease.

On this page

What causes rheumatic fever

Rheumatic fever is a type of autoimmune disease. This means it occurs when your body's immune system attacks healthy tissues and organs while trying to fight off an infection. It is commonly triggered by strep throat — a type of bacterial throat infection. It may also be caused by a strep skin infection.

In some tamariki and rangatahi, the immune system response to strep infections affects other parts of their body, including their heart, skin, joints, and brain, causing the symptoms of rheumatic fever. Why this happens in some people and not others is unclear. There is no test that tells us who will have this immune response and who will not.

How bacterial strep infections spread

The bacterial strep infection which can cause rheumatic fever spreads from person to person through:

  • coughing and sneezing
  • contact with strep germs on the skin
  • contact with strep germs on contaminated surfaces and objects, such as drinking bottles, shared cutlery, and bedding. 

If you do not have symptoms you can still potentially spread the infection to others.

A sore throat is the main symptom of strep throat. In young children signs of a sore throat can include:

  • finding it hard to swallow
  • having trouble eating or drinking.

If you have a skin infection from the strep germ it can cause:

  • itchy red skin with blisters that crust and scab (usually around the nose, mouth or legs)
  • redness, warmth, swelling and tenderness or painful skin.

It is important to get skin infections checked so they do not lead to more serious infections.

Skin infections — KidsHealth (external link)

Preventing strep germs spreading

To avoid strep germs spreading you should also:

  • avoid sharing drink bottles, food or knives and forks, or pre-chewing your baby's food — this can pass strep germs from one person to another
  • avoid preparing food for others while unwell or if you have a skin infection, if possible
  • cover your mouth and nose when coughing or sneezing, throw away the tissue afterwards, wash and dry your hands thoroughly with soap and water.

Sore throat checks

Māori and Pacific tamariki and rangatahi aged 4 to 19 should get a sore throat checked every time they occur.

Where to get a sore throat checked

There are lots of places to get a sore throat checked.

  • You can go to your usual doctor or Hauora Māori provider. Let them know your tamariki or rangatahi has a sore throat when you call to book an appointment. They may have specialist nurses available to see you quickly. 
  • Pharmacies in some areas can do sore throat checks and treatment for high-risk children and young adults. 
    Sore throat checks (internal link)
  • Your child's school may have a free sore throat check programme. Contact their school to find out. 

If you have immediate concerns about your child's sore throat or a skin infection, you can also call Healthline.

Call Healthline: 0800 611 116 (external link)

If tamariki and rangatahi have a sore throat which could be strep throat, they will be given antibiotics to clear up the infection before it can develop into rheumatic fever. A full course of antibiotics is 10 days. It is important they take the full course of antibiotics, even if they feel better. This makes it much less likely that strep throat will lead to rheumatic fever, which can cause serious complications and typically requires hospital treatment.

Symptoms of rheumatic fever

Rheumatic fever usually starts 1 to 5 weeks after tamariki and rangatahi have had strep throat or a strep skin infection.

If you or your tamaiti have any of the following symptoms, take them to your healthcare provider as soon as possible.

  • Sore joints. These are the most common symptom of rheumatic fever. This includes the hip, knees, elbows, ankles and wrists. Different joints may be sore on different days. Sore joints may cause a limp or difficulty walking due to pain. 
  • Joints that are red, swollen and feel hot.
  • Shortness of breath — you may feel short of breath more easily than usual when you are active.
  • A rash. 
  • Small painless lumps under the skin over the elbows, wrists, knees, ankles or spine.
  • Unusual jerky movements of your hands, feet, tongue and face. This can look like fidgeting or being unable to sit still, and can affect your handwriting. The movements stop during sleep.

Over time, most of these symptoms will go away. But heart damage can be permanent.

Other less common symptoms can include:

  • tummy pains
  • weight loss
  • extreme tiredness
  • an ongoing fever at or greater than 38° C that lasts a few days. 

Rheumatic heart disease

Rheumatic heart disease is a serious disease of the heart. It is caused by rheumatic fever and involves damage to one or more of the 4 small heart valves. Heart valve damage can remain after other symptoms of rheumatic fever have gone. 

During rheumatic fever, the heart valve tissue and sometimes other parts of the heart (the heart lining or muscle) can become swollen, inflamed, or both (carditis), which can cause scarring. When the heart is damaged in this way, it stops the heart valve from functioning properly. This is called rheumatic heart disease. People with severe rheumatic heart disease may need surgery to repair or replace damaged heart valves.

Complications of rheumatic heart disease

Complications include heart failure, which means the heart is unable to pump blood effectively. The strain causes the heart to enlarge. Other complications of rheumatic heart disease include:

  • infection of damaged heart valves (infective endocarditis)
  • stroke due to clots forming in the enlarged heart, or on damaged valves.

Who is most at risk

Māori or Pacific tamariki and rangatahi aged between 4 and 19 are most at risk of developing rheumatic fever, especially those who:

  • have a whānau or family history of rheumatic fever, rheumatic heart disease or both
  • live in a large household or crowded house
  • experience difficulties accessing or have been excluded from primary health care
  • drink sugar sweetened beverages daily. 

If you or your tamariki or rangatahi are in any of these groups you should get a sore throat or skin infection every time they occur. A child can get rheumatic fever more than once. 

Diagnosing rheumatic fever

If your or your tamariki and rangatahi have symptoms of rheumatic fever, you may be admitted to hospital for testing. These tests will confirm whether they have rheumatic fever or not. The tests may include:

  • a blood test
  • a throat swab
  • an electrocardiogram (also known as an ECG, this records the electrical signal from the heart to check for different heart conditions)
  • an echocardiogram (sound waves to show how blood flows through the heart and heart valves).

You may need to stay in hospital for quite a few days while the tests are completed.

The role of public health

Rheumatic fever is a notifiable disease. This means that healthcare providers or laboratories will inform public health when someone has it. This way, we can monitor how many people are sick and give advice on how to reduce its spread.

Public health nurses will work with whānau who have rheuamtic fever to help prevent others from getting sick. They can also help refer whānau to other health and housing services to reduce the risk of rheumatic fever occurring again.

Living with rheumatic fever and rheumatic heart disease

Rheumatic fever has long-lasting consequences. Repeated episodes of rheumatic fever can make rheumatic heart disease worse.

To prevent more episodes of rheumatic fever that can lead to rheumatic heart disease, it is important to stop further strep throat infections. This requires penicillin injections every 28 days for at least 10 years. These injections may be needed into adulthood.

If you or your tamariki and rangatahi have rheumatic fever you may also require:

  • time off school
  • to reduce or stop exercise until your body has recovered — you should only return to normal activity when it is determined safe by your medical team
  • regular dental checks and extra care of teeth and gums
  • an annual flu vaccine as well as your regular childhood and COVID-19 immunisations.

The flu vaccine is free for people who have rheumatic heart disease. Immunisations are important for people who have had rheumatic fever to prevent other illnesses which can affect heart health, like flu and COVID-19.

Services and support

Your local health district will have services to help coordinate care if you need antibiotics to help prevent acute rheumatic fever occurring again, or rheumatic heart disease. 

Dentist visits

If you or your tamariki and rangatahi have had rheumatic fever or has rheumatic heart disease tell your oral health professional, such as a dentist, dental nurse, hygienist or therapist. 

Some tamariki and rangatahi may need antibiotics before having dental work done. This is to help reduce the chance of any infection reaching their heart during the dental procedure. 

Dental care is free for all tamariki and rangatahi up until their 18th birthday.

Dental care (internal link)

How to prevent rheumatic fever

Keeping your home warm and dry will reduce the risk of germs like strep throat from spreading. If possible, having your whānau or family sleep in separate rooms and beds can also help. 

The Healthy Homes Initiative helps eligible families to create a warmer, drier, healthier home. Its providers can support you to create a healthier living environment, reducing the risk of germs spreading.

Healthy Homes Initiative — Health New Zealand (external link)