Neilson G, Streatfield R W, West M, Johnson S, Glavin W, Baird S
Department of Cardiology, Prince Charles Hospital, Chermside, Qld.
Med J Aust. 1993 Mar 1;158(5):316-8.
To establish a program for the prevention of rheumatic fever and rheumatic heart disease in a semi-isolated Aboriginal community in far north Queensland and to test its efficacy.
A prevalence study of acute rheumatic fever and chronic rheumatic heart disease was conducted in the community in 1985 and subjects with possible acute rheumatic fever were assessed. A prophylactic antibiotic program was instituted. Records were kept of the prevalence of acute rheumatic fever for six years after the 1985 survey. A second survey of the community was held in 1991 to detect chronic rheumatic carditis resulting from undetected acute rheumatic fever.
The Yarrabah Aboriginal community in north Queensland (latitude 17 degrees S). The program was conducted by the Yarrabah Health Team, a part of the North Queensland Aboriginal Health Division.
The whole Yarrabah community (population 1250) was invited to participate. In 1985, after the completion of an educational program, 89% of the community cooperated in the survey. There was no educational program before the 1991 survey and the compliance rate was much lower. Importantly, however, 87% of the vulnerable group (4-16 year olds) were examined.
After the 1985 survey, all community members aged 4-16 years had throat swabs taken three times each year. Those with swabs showing Group A streptococci were treated; their contacts were also swabbed and treated if Group A streptococci were found.
Before the institution of the swabbing program there were four new cases of acute rheumatic fever each year in the Yarrabah community. In the six years after the program was introduced only one case of acute rheumatic fever occurred. This was at a time when swabbing had temporarily lapsed for a three-month period.
These results support the use of a prophylactic antibiotic program in Aboriginal communities as a cost effective and efficient method for the prevention of rheumatic fever. The cooperation of the community is an integral part of its success and this can be obtained by community education.
在昆士兰远北地区一个半隔离的原住民社区建立预防风湿热和风湿性心脏病的项目，并测试其效果。
1985年在该社区开展了急性风湿热和慢性风湿性心脏病的患病率研究，并对可能患有急性风湿热的受试者进行了评估。制定了预防性抗生素项目。记录了1985年调查后六年内急性风湿热的患病率。1991年对该社区进行了第二次调查，以检测未被发现的急性风湿热导致的慢性风湿性心内膜炎。
昆士兰北部的亚拉巴原住民社区（南纬17度）。该项目由北昆士兰原住民健康部门下属的亚拉巴健康团队实施。
邀请了整个亚拉巴社区（人口1250人）参与。1985年，在完成一项教育项目后，89%的社区居民参与了调查。1991年调查前没有开展教育项目，依从率低得多。然而，重要的是，87%的弱势群体（4至16岁）接受了检查。
1985年调查后，所有4至16岁的社区成员每年进行三次咽拭子检查。咽拭子显示A组链球菌的人接受治疗；如果发现A组链球菌，其接触者也进行咽拭子检查并接受治疗。
在实施咽拭子检查项目之前，亚拉巴社区每年有4例急性风湿热新病例。在该项目实施后的六年中，仅发生了1例急性风湿热病例。这是在咽拭子检查暂时中断了三个月的时候发生的。
这些结果支持在原住民社区使用预防性抗生素项目，作为预防风湿热的一种经济有效且高效的方法。社区的合作是该项目成功不可或缺的一部分，这可以通过社区教育来实现。
