University leads $10 million rheumatic fever project

The University of Auckland’s medical faculty will lead a multi-million dollar government-funded project to support vaccine development to help prevent rheumatic fever and rheumatic heart disease.

The initiative tackles one of the nation’s glaring health inequities.

Māori and Pacific tamariki and rangatahi between the ages of four and 19 years old have the highest rates of rheumatic fever. Among Pacific peoples, rheumatic fever occurs mainly in Samoan and Tongan children and young people.

Associate Professor Nikki Moreland, paediatric infectious diseases consultant Dr Rachel Webb and Dr Anneka Anderson (Kāi Tahu, Kāti Māmoe) of Te Kupenga Hauora Māori will lead the work, set to begin in 2022.

The research will involve collaboration with Australia.

“Because New Zealand and Australia are among the few developed countries to still have rheumatic fever, it makes sense for us to collaborate to develop a vaccine,” Associate Minister of Health Dr Ayesha Verrall said when she announced the project on 19 November.

Rheumatic fever starts from a strep throat infection, and causes the heart, joints, brain and skin to become inflamed and swollen.

Funding of $10 million will also support activities such as enhanced surveillance of Strep A, more infrastructure for laboratory testing, and preparations to ensure Aotearoa New Zealand is ready to conduct clinical trials.

“Rheumatic fever can have a devastating impact, especially for Māori and Pacific children and young people,” Ayesha Verrall said.

“As an infectious diseases doctor, I cared for rangatahi who experienced some of the worst outcomes from this illness. Several had heart valve replacements that became infected, and some suffered strokes. I remember one young woman who needed a heart transplant, and later tragically died.”

In 2020/21, 107 people were hospitalised for the first time with rheumatic fever in New Zealand. People who’ve caught rheumatic fever need to have monthly antibiotic injections for at least 10 years, to prevent it from returning and developing into rheumatic heart disease.

Dr Moreland said an effective Strep A vaccine "could ultimately end rheumatic fever in Aotearoa" but the project was not without challenges. "This funding is a huge step forward and will enable New Zealand to make a major contribution to global efforts, whilst also building and growing local capability," she said. "We envisage that vaccine development sits alongside a wider strategy for the prevention and management of Strep A diseases and rheumatic fever, which addresses immediate needs in the community."

Dr Anneka Anderson added that “through inclusion of Kaupapa Māori and Pacific health research approaches, and community voices, this equity-based initiative will provide a culturally responsive intervention to work towards elimination of rheumatic fever in Aotearoa”.