Australia has one of the highest rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the world. Indigenous people are up to eight times more likely than other groups to be hospitalised and nearly 20 times as likely to die from this disease.

ARF is caused by an immunological response to group A streptococcal (GAS) infection and can lead to permanent heart damage, a condition known as RHD. Globally, RHD is the most common cause of cardiac death in children and adults aged under 40 years. However, through simple and cost effective strategies, almost all cases of RHD and associated deaths are preventable.

There are at least 15.6 million people with RHD worldwide and, annually, over 230 000 people die from the disease. There are another 1.9 million people with a history of ARF and 470 000 new cases are diagnosed every year. These figures, however, are likely to be an underestimate of the true burden of the disease.

Some of the highest rates of ARF and RHD in the world are found in Indigenous Australians (particularly across central and northern Australia), Maoris and Pacific Island populations. The Pacific region, including Fiji, has the highest reported prevalence of RHD. The prevalence of RHD is also high in sub-Saharan Africa, Latin America, the Indian subcontinent, the Middle East and Northern Africa. Menzies' researchers work with high risk populations in Australia and the Pacific Region.

Incidence of ARF and RHD falls dramatically with improved living conditions and increased hygiene standards, along with better access to appropriate health services and penicillin-based medications (known as secondary prophylaxis).

Menzies’ research mainly targets primary and secondary prevention of ARF and RHD. This means stopping people from getting the disease in the first place, but if they do get it, treating them to keep them healthy.

Our research focus:
  • To test whether a model of care designed to optimise health systems and community resources improves adherence to secondary prophylaxis for RHD
  • To understand why ARF converts to RHD in some people. Many Indigenous Australians will get group A streptococcus infections but only some will develop RHD. Launched in 2012, RHD Genetics is a collaborative study into the role genetics plays in the disease’s presence and progression
  • To provide an evidence base to improve clinical care and outcomes for women with RHD in pregnancy and for their babies
  • To find markers in the blood that can be used to rapidly and accurately diagnose ARF so people can get the treatment they need as soon as possible
  • To establish the prevalence of RHD in high-risk Indigenous Australian children and to compare the findings with children at low risk for RHD and to determine the accuracy of cardiac auscultation in detecting echocardiographically- confirmed RHD
  • To provide direct program support and conduct research under the World Heart Federation RHD Pacific and International Program, including:
    • RHD genetics study in Fiji and New Caledonia.
    • A BPG adherence study in Fiji
    • A cost analysis of burden of RHD in New Caledonia and Fiji
    • An evaluation of the ASAP RHD program in South Africa and Ethiopia
    • Development of an RHD train the trainer module for international and regional Pacific use
    • Collaboration and sharing of resources with many other countries in Asia, Africa and South America.
Research translation:
RHDAustralia was established in 2009 to support control and prevention initiatives for ARF and RHD in Australia. RHDA works alongsidehealth service providers, Aboriginal and Torres Strait Islander peoples, and other at risk populations, to reduce acute rheumatic fever and rheumatic heart disease in Australia, through the following activities: 
  • Updating, disseminating and integrating the 3rd edition of the Australian Guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease
  • Developing and implementing high quality, evidence based education and training resources for health professionals, people with ARF/ RHD, their families and communities; and 
  • Supporting health systems to achieve evidence-based best practice for focused prevention activities in high-risk communities
For more information on the work being done by RHDA, please visit the website