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Primary prevention of rheumatic fever in the 21st century: evaluation of a national programme.
Jack, Susan J; Williamson, Deborah A; Galloway, Yvonne; Pierse, Nevil; Zhang, Jane; Oliver, Jane; Milne, Richard J; Mackereth, Graham; Jackson, Catherine M; Steer, Andrew C; Carapetis, Jonathan R; Baker, Michael G.
Afiliación
  • Jack SJ; Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
  • Williamson DA; Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand.
  • Galloway Y; Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand.
  • Pierse N; Doherty Applied Microbial Genomics, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
  • Zhang J; Microbiological Diagnostic Unit Public Health Laboratory, University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
  • Oliver J; Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand.
  • Milne RJ; Department of Public Health, University of Otago, Wellington, New Zealand.
  • Mackereth G; Department of Public Health, University of Otago, Wellington, New Zealand.
  • Jackson CM; Department of Public Health, University of Otago, Wellington, New Zealand.
  • Steer AC; School of Population Health, University of Auckland, Auckland, New Zealand.
  • Carapetis JR; Health Intelligence Team, Institute of Environmental Science and Research, Wellington, New Zealand.
  • Baker MG; Planning, Funding and Outcomes, Waitemata and Auckland District Health Board, Auckland, New Zealand.
Int J Epidemiol ; 47(5): 1585-1593, 2018 10 01.
Article en En | MEDLINE | ID: mdl-30060070
Background: Acute rheumatic fever (ARF) has largely disappeared from high-income countries. However, in New Zealand (NZ) rates remain high in indigenous (Maori) and Pacific populations. In 2011, NZ launched an intensive and unparalleled primary Rheumatic Fever Prevention Programme (RFPP). We evaluated the impact of the school-based sore throat service component of the RFPP. Methods: The evaluation used national trends of all-age first episode ARF hospitalisation rates before (2009-11) and after (2012-16) implementation of the RFPP. A retrospective cohort study compared first-episode ARF incidence during time-not-exposed (23 093 207 person-days) and time-exposed (68 465 350 person-days) with a school-based sore throat service among children aged 5-12 years from 2012 to 2016. Results: Following implementation of the RFPP, the national ARF incidence rate declined by 28% from 4.0 per 100 000 [95% confidence interval (CI) 3.5-4.6] at baseline (2009-11) to 2.9 per 100 000 by 2016 (95% CI 2.4-3.4, P <0.01). The school-based sore throat service effectiveness overall was 23% [95% CI -6%-44%; rate ratio (RR) 0.77, 95% CI 0.56-1.06]. Effectiveness was greater in one high-risk region with high coverage (46%, 95% CI 16%-66%; RR 0.54, 95% CI 0.34-0.84). Conclusions: Population-based primary prevention of ARF through sore throat management may be effective in well-resourced settings like NZ where high-risk populations are geographically concentrated. Where high-risk populations are dispersed, a school-based primary prevention approach appears ineffective and is expensive.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prevención Primaria / Fiebre Reumática / Servicios de Salud Escolar / Hospitalización Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male País/Región como asunto: Oceania Idioma: En Revista: Int J Epidemiol Año: 2018 Tipo del documento: Article País de afiliación: Nueva Zelanda Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prevención Primaria / Fiebre Reumática / Servicios de Salud Escolar / Hospitalización Tipo de estudio: Diagnostic_studies / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male País/Región como asunto: Oceania Idioma: En Revista: Int J Epidemiol Año: 2018 Tipo del documento: Article País de afiliación: Nueva Zelanda Pais de publicación: Reino Unido