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Abstract:
This paper describes a prolonged outbreak of APSGN in a remote Aboriginal community in 2005 that has experienced outbreaks in 1980, 1987, 1994 and 2000 and the interventions undertaken to limit further cases. Introduction: Acute post-streptococcal glomerulonephritis (APSGN) is an inflammatory disease of the kidneys following Group A streptococcal (GAS) infections. Clinical characteristics are oedema, hypertension and glomerular haematuria with reduced serum complement levels.1 Some evidence suggests that recurrent or persistent episodes of APSGN are associated with the high prevalence of end stage renal disease in Indigenous Australians.2, 3Sporadic cases of APSGN occur throughout Northern Territory (NT) with outbreaks every 5-7 years across the Top End.4 Targeted public health interventions are recommended to treat skin sores due to Group A Streptococcus (GAS), prevent further cases and halt outbreaks.5, 6 In 2000, 7 communities in the Top End experienced outbreaks and implemented such interventions.7From October 2004 an increase in notifications of APSGN in the NT was detected but cases appeared unrelated and from separate communities. Given this increase in sporadic cases, staff at the Centre for Disease Control (CDC) became concerned that the current outbreak case definition was not sufficiently sensitive to allow timely interventions. Therefore, in early January 2005, a more sensitive outbreak case definition was trialled. The definition was changed from 3 unrelated possible cases in 1 month,6 to 1 confirmed and 1 possible case in 3 weeks. The alternative recommended definition, 2 unrelated clinical cases of APSGN in a week,6 remained unchanged. From 1 January 2005 the revised case definitions for diseases notifiable in the NT were also introduced. The diagnostic criteria for APSGN have not significantly changed from the previous definitions, however “subclinical cases” are now referred to as “probable cases” and “clinical cases” are now referred to as “possible cases” (see Table 1).
