New Method to Prevent Rheumatic Fever Faces Roadblocks Amid Surge

Rheumatic fever cases in New Zealand have surged to an 18-year high, prompting urgent discussions about prevention strategies. Despite a promising trial of a new method to administer penicillin that could make treatment less painful and more efficient, the implementation of this technique faces significant obstacles.

The current method of administering penicillin for rheumatic fever involves painful intramuscular injections every 28 days. For patients like Paige Raemaki, who began her treatment at seven years old, these injections have been a source of fear and distress. Now 20, Raemaki is set to complete her regular injections but has participated in a trial that could revolutionize treatment for many.

Promising Trials for a Painful Condition

The trial, conducted by researchers in Wellington, explored subcutaneous injections of penicillin, which have shown to last longer—up to three months—compared to the traditional method. This approach not only reduces the frequency of injections but also lessens the associated pain. As Julie Bennett, an associate professor in public health at Otago University, explains, the trial has garnered positive feedback from participants, with over 400 subcutaneous injections administered.

Nurse Dhevindri Moodley, who has worked with children receiving intramuscular penicillin injections for years, noted that the new method significantly enhances patient compliance. “It’s not pain-free, but in terms of compliance, it has been a game changer,” she stated. The trial has allowed patients to manage their treatment more effectively, accommodating their busy lives, and reducing the burden on healthcare providers.

Despite the trial’s success, challenges remain in integrating the new method into national healthcare protocols. Health authorities have been slow to adopt the subcutaneous method, citing a lack of evidence supporting its effectiveness compared to the traditional approach. According to Deborah Woodley, director of starting well at Health NZ, intramuscular penicillin “remains the only evidence-based treatment.”

Rising Cases of Rheumatic Fever

The surge in rheumatic fever cases is alarming, particularly as it is a disease often associated with poverty and inadequate healthcare access. New Zealand has witnessed a rise in first hospitalizations due to rheumatic fever, with 194 cases recorded in recent years. Pacific communities are disproportionately affected, facing hospitalization rates four times higher than Māori and significantly more than other ethnicities.

Despite substantial investment in prevention programs since 2011, access to treatment remains inconsistent across different regions. Nina Bevin, clinical director for the National Hauora Coalition, highlighted the barriers that many high-risk groups face in accessing primary care. “A lot of the kids that our teams are seeing aren’t enrolled in primary care,” she noted, which complicates efforts to identify and treat infections early.

The lack of equitable access to care is underscored by a recent stocktake of rheumatic fever services, revealing that while high-risk populations in the North Island have access to free sore throat checks and antibiotic treatment at schools and pharmacies, those in the South Island must rely solely on general practitioners.

As the researchers continue to advocate for the subcutaneous method, the need for a comprehensive and unified approach to rheumatic fever prevention and treatment in New Zealand is becoming increasingly evident.

While Health NZ spends approximately $8 million annually on managing rheumatic fever, the system’s fragmentation hampers effective delivery. “The rheumatic fever system is so broken in New Zealand—every area does it differently,” Moodley stated.

With the trial funding having ended, the researchers are pushing for wider adoption of the subcutaneous injection method. They argue that implementing this change could lead to better outcomes for patients and more efficient use of healthcare resources.

As New Zealand grapples with rising rheumatic fever cases, it must confront the challenges of outdated treatment methods and inequitable healthcare access to prevent a disease that, in many developed countries, is considered a relic of the past.