State of child health: acute rheumatic fever in Aotearoa New Zealand.

Rheumatic fever is a well-recognised public health problem in Aotearoa New Zealand that is potentially preventable by addressing the social and environmental determinants of health and ensuring equitable access to primary healthcare services. We present data on the hospitalisations of children aged 0-14 years for acute rheumatic fever (ARF) during the period 2000-2020, and the early stages of the COVID-19 pandemic to May 2021. Persistent inequity by ethnicity and by socioeconomic deprivation was observed, particularly for Pacific children, for Māori children, and for children living in the most deprived areas (NZDep quintile 5). The government implemented a programme to prevent rheumatic fever between July 2012 and June 2017. Hospitalisation data suggest that the programme was reducing the incidence of ARF in children, but this trend was not sustained. There was minimal change to the number of hospitalisations for ARF during early period of the COVID-19 pandemic. If untreated, ARF can cause chronic rheumatic heart disease. The persistently high rates of hospitalisations and the unequal burden of disease for vulnerable groups should no longer be tolerated, since they can be effectively addressed by implementation of evidence-based strategies to prevent, treat, and control this disease.