Eradication of rheumatic fever has become a New Zealand health priority in recent years, with the Government investing $65 million across a series of interventions aimed at drastically reducing rheumatic fever incidence by 2017.1 It is possible to prevent rheumatic fever occurrence via the timely treatment of Group-A Streptococcal (GAS) infection with penicillin antibiotics.2 Given that rheumatic fever is primarily a disease of childhood,3,4 the decision to seek care generally rests with someone else invariably the sick child s parent or caregiver who will make this decision based on their own experiences and knowledge. Sore throat awareness, then, is a crucial element of rheumatic fever prevention part of which is an understanding of the potential consequences of sore throats, and what can be done to prevent them.5 Little is understood about awareness in these respects among those who belong to the highest-risk population.We interviewed the parents/caregivers of those children who were diagnosed with either definite, probable or possible/borderline RHD during the recent school-based rheumatic heart disease (RHD) echocardiographic screening programmes, conducted in multiple district health boards between 2007-2012 ( case respondents , n=91; age 12.2 years [SD 1.4], 64% of those invited to participate). We also interviewed the parents/caregivers of at least two DHB-matched controls whose scan showed no cardiac abnormality ( control respondents ; n=185, age 11.9 years [SD 1.3], 51% of those invited to participate). Matching solely on study region allowed an approximate match of cases to controls by geographic region, age, socio-economic status and time since the screening event and, to a lesser extent, ethnicity.The majority of the screened children were Mori ( abnormal cases: 52%; normal controls: 56%) or Pacific (cases: 48%; controls: 34%), with a minority being non-Mori/non-Pacific (cases: 5%; controls: 17%). The vast majority of both case (87%) and control (89%) respondents were parents of the screened child. The interview (79% telephone, 21% in-person) included a series of questions pertaining to rheumatic fever and sore throat awareness, and was conducted by trained interviewers using Computer-Assisted Personal Interview (CAPI) technology. The results are shown in Table 1.Table 1: Respondent awareness with respect to sore throats and the rheumatic fever. Abnormal Result Normal Result n % n % P Rheumatic fever Ever heard of rheumatic fever 84 92% 175 95% 0.458 What do you think rheumatic fever is caused by?1,2 Sore throats 71 78% 121 65% 0.033 Cold weather 14 15% 28 15% 0.957 Joint infections 13 14% 26 14% 0.959 Don t know 10 11% 33 18% 0.141 Which part of the body can rheumatic fever affect?1 0.01 Kidneys 2 2% 2 1% Heart 82 98% 152 87% Liver 0 0% 2 1% Don t know 0 0% 19 11% Sore throats If a child has a sore throat, what is the best thing to do? 0.335 Wait a few days and see if it gets better 7 8% 16 9% See the nurse or doctor straight away 81 89% 152 82% Get something like throat lozenges for it 2 2% 13 7% Don t know 1 1% 4 2% Can you catch a sore throat from someone else? 0.29 Yes 59 65% 138 75% No 21 23% 26 14% Only if you are run down 3 3% 6 3% Don t know 8 9% 15 8% Have you ever heard of strep throat ? 60 66% 142 77% 0.057 What is the best treatment for strep throat ?3 0.334 Antibiotics 56 93% 122 86% Rest and wait for it to go away 2 3% 4 3% Other 0 0% 2 1% Don t Know 2 3% 14 10% 1Multiple responses were allowed. 2Among those who had heard of rheumatic fever. 3Among those who had heard of strep throat . Almost all respondents had heard of rheumatic fever, with no difference observed between case (92%) and control respondents (95%; p=0.458). When asked to select from a list regarding what causes rheumatic fever, the majority of respondents identified sore throats , with more case respondents (78%) than control respondents (65%) doing so (p=0.033).High levels of sore throat awareness were observed regarding the best thing to do if a child has a sore throat with the majority of both case respondents (89%) and control respondents (83%) saying that they should see a doctor or nurse straight away. The majority of respondents correctly identified that it was possible to catch a sore throat from someone else; however, nearly a third (32%) of case respondents and nearly a quarter (22%) of control respondents either said no or don t know . This observation is similar to that observed among New Zealand school-aged children who were asked the same question, in which less than half (49%) knew that sore throats were catching.6The vast majority of both case (93%) and control (86%) respondents understood that a strep throat needed to be treated with antibiotics a substantially higher proportion than that observed recently in the US, where 62% of Medicaid-insured adult respondents had this understanding.7Overall, these observations are heartening: they represent a generally high level of rheumatic fever and sore throat awareness among a population at high risk3,4 of rheumatic fever or, more accurately, a population at high risk of caring for a child with rheumatic fever. While the majority of respondents demonstrated a high level of awareness with respect to the contagious nature of sore throats, the fact that a substantial minority did not have this understanding suggests an opportune target for further public health education.The New Zealand Ministry of Health has, in recent years, funded a rheumatic fever prevention programme (RFPP),8 which includes a substantial rheumatic fever and sore throat awareness component with this programme being initiated after the current cohort received screening for rheumatic heart disease, but before the respondents were interviewed. Based on international comparison7 and recent evidence in the New Zealand context of a temporal improvement in awareness among this high-risk population,9 we might conclude that the generally high rheumatic fever and sore throat awareness that we observed most likely reflects the current RFPP and its extensive publicity campaign, rather than education at the time of the RHD screening, which took place 3-8 years earlier. However, we note that it is also feasible that participation in the screening event itself affected participants knowledge about rheumatic fever, which would affect the applicability of our results to high-risk populations more generally.

Eradication of rheumatic fever has become a New Zealand health priority in recent years, with the Government investing $65 million across a series of interventions aimed at drastically reducing rheumatic fever incidence by 2017.1 It is possible to prevent rheumatic fever occurrence via the timely treatment of Group-A Streptococcal (GAS) infection with penicillin antibiotics.2 Given that rheumatic fever is primarily a disease of childhood,3,4 the decision to seek care generally rests with someone else invariably the sick child s parent or caregiver who will make this decision based on their own experiences and knowledge. Sore throat awareness, then, is a crucial element of rheumatic fever prevention part of which is an understanding of the potential consequences of sore throats, and what can be done to prevent them.5 Little is understood about awareness in these respects among those who belong to the highest-risk population.We interviewed the parents/caregivers of those children who were diagnosed with either definite, probable or possible/borderline RHD during the recent school-based rheumatic heart disease (RHD) echocardiographic screening programmes, conducted in multiple district health boards between 2007-2012 ( case respondents , n=91; age 12.2 years [SD 1.4], 64% of those invited to participate). We also interviewed the parents/caregivers of at least two DHB-matched controls whose scan showed no cardiac abnormality ( control respondents ; n=185, age 11.9 years [SD 1.3], 51% of those invited to participate). Matching solely on study region allowed an approximate match of cases to controls by geographic region, age, socio-economic status and time since the screening event and, to a lesser extent, ethnicity.The majority of the screened children were Mori ( abnormal cases: 52%; normal controls: 56%) or Pacific (cases: 48%; controls: 34%), with a minority being non-Mori/non-Pacific (cases: 5%; controls: 17%). The vast majority of both case (87%) and control (89%) respondents were parents of the screened child. The interview (79% telephone, 21% in-person) included a series of questions pertaining to rheumatic fever and sore throat awareness, and was conducted by trained interviewers using Computer-Assisted Personal Interview (CAPI) technology. The results are shown in Table 1.Table 1: Respondent awareness with respect to sore throats and the rheumatic fever. Abnormal Result Normal Result n % n % P Rheumatic fever Ever heard of rheumatic fever 84 92% 175 95% 0.458 What do you think rheumatic fever is caused by?1,2 Sore throats 71 78% 121 65% 0.033 Cold weather 14 15% 28 15% 0.957 Joint infections 13 14% 26 14% 0.959 Don t know 10 11% 33 18% 0.141 Which part of the body can rheumatic fever affect?1 0.01 Kidneys 2 2% 2 1% Heart 82 98% 152 87% Liver 0 0% 2 1% Don t know 0 0% 19 11% Sore throats If a child has a sore throat, what is the best thing to do? 0.335 Wait a few days and see if it gets better 7 8% 16 9% See the nurse or doctor straight away 81 89% 152 82% Get something like throat lozenges for it 2 2% 13 7% Don t know 1 1% 4 2% Can you catch a sore throat from someone else? 0.29 Yes 59 65% 138 75% No 21 23% 26 14% Only if you are run down 3 3% 6 3% Don t know 8 9% 15 8% Have you ever heard of strep throat ? 60 66% 142 77% 0.057 What is the best treatment for strep throat ?3 0.334 Antibiotics 56 93% 122 86% Rest and wait for it to go away 2 3% 4 3% Other 0 0% 2 1% Don t Know 2 3% 14 10% 1Multiple responses were allowed. 2Among those who had heard of rheumatic fever. 3Among those who had heard of strep throat . Almost all respondents had heard of rheumatic fever, with no difference observed between case (92%) and control respondents (95%; p=0.458). When asked to select from a list regarding what causes rheumatic fever, the majority of respondents identified sore throats , with more case respondents (78%) than control respondents (65%) doing so (p=0.033).High levels of sore throat awareness were observed regarding the best thing to do if a child has a sore throat with the majority of both case respondents (89%) and control respondents (83%) saying that they should see a doctor or nurse straight away. The majority of respondents correctly identified that it was possible to catch a sore throat from someone else; however, nearly a third (32%) of case respondents and nearly a quarter (22%) of control respondents either said no or don t know . This observation is similar to that observed among New Zealand school-aged children who were asked the same question, in which less than half (49%) knew that sore throats were catching.6The vast majority of both case (93%) and control (86%) respondents understood that a strep throat needed to be treated with antibiotics a substantially higher proportion than that observed recently in the US, where 62% of Medicaid-insured adult respondents had this understanding.7Overall, these observations are heartening: they represent a generally high level of rheumatic fever and sore throat awareness among a population at high risk3,4 of rheumatic fever or, more accurately, a population at high risk of caring for a child with rheumatic fever. While the majority of respondents demonstrated a high level of awareness with respect to the contagious nature of sore throats, the fact that a substantial minority did not have this understanding suggests an opportune target for further public health education.The New Zealand Ministry of Health has, in recent years, funded a rheumatic fever prevention programme (RFPP),8 which includes a substantial rheumatic fever and sore throat awareness component with this programme being initiated after the current cohort received screening for rheumatic heart disease, but before the respondents were interviewed. Based on international comparison7 and recent evidence in the New Zealand context of a temporal improvement in awareness among this high-risk population,9 we might conclude that the generally high rheumatic fever and sore throat awareness that we observed most likely reflects the current RFPP and its extensive publicity campaign, rather than education at the time of the RHD screening, which took place 3-8 years earlier. However, we note that it is also feasible that participation in the screening event itself affected participants knowledge about rheumatic fever, which would affect the applicability of our results to high-risk populations more generally.