Acute post-streptococcal glomerulonephritis (APSGN) in the Torres Strait and Cape York: surveillance insights pre- and post- mandatory notification

Acute post-streptococcal glomerulonephritis (APSGN) is an immune-mediated kidney condition, typically affecting children. While the incidence has declined in urban Australia, APSGN remains a major concern in rural and remote communities, particularly among First Nations children. This study describes the epidemiology of APSGN in the Torres Strait and Cape York region of Far North Queensland (FNQ) over a three-year period, from January 2022 to December 2024, which spanned pre- and post-mandatory public health notification of APSGN in Queensland. Cases were initially identified through electronic medical record alerts and later augmented by clinical notification when APSGN became notifiable in Queensland in October 2023. Over the three years of our study period, there were 75 confirmed, probable and possible cases identified, including outbreaks on Waiben (Thursday Island) and New Mapoon. The median age of cases was six years (interquartile range: 4-9 years), with 92% of cases occurring in children under 15, all from First Nations backgrounds. The 63 confirmed and probable cases in children under 15 represent an incidence within this population of 390 cases per 100,000 person-years (95% confidence interval: 294-486 per 100,000 person-years), ostensibly the highest documented rate globally. In the modern era, the burden of this preventable disease for FNQ First Nations children is the highest in the world. Progress will only be made by addressing the underlying social determinants of health, including childhood disadvantage and household crowding.