Lay summary
Increasing evidence suggests that acute rheumatic fever (ARF) is primarily caused by scabies infestation. (Scabies leading to Group A Strep infection in skin leading to ARF) Scabies is an important cause of health inequality in New Zealand, almost exclusively affecting Pasifika and Māori children. It leads to scarring of heart valves, and often, early death. Rash associated with scabies is confused with skin diseases, such as eczema or insect bites. Building on findings from our 2019 HRC Pacific project study that found scabies infestation common in early child education centres in south Auckland (50-60%), we propose a case-control study which may dramatically change the focus for ARF prevention in New Zealand, with a focus on scabies. The study will compare evidence for scabies infestation among cases of ARF and their families with population controls. This could prevent over 200 cases of ARF each year and address massive inequities Pasifika and Māori children.