TY - JOUR T1 - Acute rheumatic fever in First Nations communities in northwestern Ontario JF - Canadian Family Physician JO - Can Fam Physician SP - 881 LP - 886 VL - 61 IS - 10 AU - Janet Gordon AU - Mike Kirlew AU - Yoko Schreiber AU - Raphael Saginur AU - Natalie Bocking AU - Brittany Blakelock AU - Michelle Haavaldsrud AU - Christine Kennedy AU - Terri Farrell AU - Lloyd Douglas AU - Len Kelly Y1 - 2015/10/01 UR - http://www.cfp.ca/content/61/10/881.abstract N2 - Objective To document a case series of 8 young First Nations patients diagnosed with acute rheumatic fever (ARF), a preventable disease that resulted in the death of 2 patients, in northwestern Ontario in the context of late diagnosis, overcrowded housing, and inadequate public health response.Design Retrospective case series over an 18-month period.Setting Remote First Nations communities in northwestern Ontario.Participants Eight patients with ARF.Main outcome measures Incidence, mortality, residual rheumatic heart disease, time to diagnosis, barriers to diagnosis and treatment, housing situation of patients, patient demographic characteristics (age, sex), and investigation results.Results The incidence of ARF in this population was 21.3 per 100 000, which is 75 times greater than the overall Canadian estimated incidence. The average patient age was 9.4 years. Most cases developed joint findings, and 5 of the surviving patients had rheumatic heart disease when they received echocardiography. The average time to diagnosis was 88 days. Two 4-year-old children died from ARF. Most patients lived in inadequate and crowded housing.Conclusion This rare disease still exists in remote First Nations communities. These communities demonstrate an incidence equal to that in aboriginal communities in Australia and New Zealand, which have among the highest international incidence of ARF. Primordial prevention, including improved on-reserve housing, is urgently needed. Case detection and ongoing surveillance for primary and secondary prophylaxis requires a well resourced regional strategy. ER -