Rosemary Wyber
Senior Research Fellow
MBChB MPH FRACGP PhD
Dr Rosemary Wyber is a general practitioner and researcher focusing on Aboriginal and Torres Strait Islander cardiovascular health. Dr Wyber completed her medical training in New Zealand, her Master of Public Health at the Harvard School of Public Health and general practice training in Aboriginal Community Controlled Clinics in the Northern Territory of Australia. Dr Wyber’s research has focused on rheumatic heart disease, in Australia and internationally. She was the lead author of the RHD Endgame Strategy to eliminate RHD in Australia by 2031 and her PhD thesis addresses policy options to address RHD. She is a Chief Investigator on the NHMRC STARFISH Synergy grant. Dr Wyber is a Senior Adjunct Research Fellow at The University of Western Australia.
Dr Wyber is also a Research Fellow at Australian National University on chronic disease risk assessment and management for Aboriginal and Torres Strait Islander people within the National Centre for Aboriginal and Torres Strait Islander Wellbeing Research.
Projects
The END RHD CRE: Developing an end game for rheumatic heart disease in Australia
Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis
RHD Action
September 2020
Reach: to stop rheumatic heart disease
September 2020
Pharmacokinetics of intramuscular versus subcutaneous administration of Benzathine Penicillin G
Improving Wellbeing for Young People Living with Rheumatic Heart Disease: A peer support program through Danila Dilba Health Service
END RHD Demonstration Communities
September 2020
END RHD Community Project - Kimberley (Rheumatic Fever Strategy)
END RHD
September 2020
Burden of rheumatic heart disease (RHD) and impact of prevention strategies: comprehensive evidence to drive the RHD Endgame
Published research
A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care
More than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations.
The epidemiology of superficial Streptococcal A (impetigo and pharyngitis) infections in Australia: A systematic review
Streptoccocal A (Strep A, GAS) infections in Australia are responsible for significant morbidity and mortality through both invasive (iGAS) and post-streptococcal (postGAS) diseases as well as preceding superficial (sGAS) skin and throat infection. The burden of iGAS and postGAS are addressed in some jurisdictions by mandatory notification systems; in contrast, the burden of preceding sGAS has no reporting structure, and is less well defined.
Research priorities for the secondary prevention and management of acute rheumatic fever and rheumatic heart disease: a National Heart, Lung, and Blood Institute workshop report
Secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) involves continuous antimicrobial prophylaxis among affected individuals and is recognised as a cornerstone of public health programmes that address these conditions. However, several important scientific issues around the secondary prevention paradigm remain unresolved.
Getting to grips with invasive group A streptococcal infection surveillance in Australia: are we experiencing an epidemic?
Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol
Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule.
Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol
Rheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease.
Modalities of group A streptococcal prevention and treatment and their economic justification
Infection by group A Streptococcus (Strep A) results in a diverse range of clinical conditions, including pharyngitis, impetigo, cellulitis, necrotising fasciitis, and rheumatic heart disease. In this article, we outline the recommended strategies for Strep A treatment and prevention and review the literature for economic evaluations of competing treatment and prevention strategies.
Surgery for rheumatic heart disease in the Northern Territory, Australia, 1997-2016: what have we gained?
Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia, was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in survival.
Improving primary care for Aboriginal and Torres Strait Islander people with rheumatic heart disease: What can I do?
Acute rheumatic fever and rheumatic heart disease disproportionately affect Aboriginal and Torres Strait Islander people in Australia, with devastating impacts on morbidity, mortality and community wellbeing. Research suggests that general practitioners and primary care staff perceive insurmountable barriers to improving clinical outcomes, including the need for systemic change outside their scope of practice.
Evaluation of a Community-Led Program for Primordial and Primary Prevention of Rheumatic Fever in Remote Northern Australia
Environmental factors including household crowding and inadequate washing facilities underpin recurrent streptococcal infections in childhood that cause acute rheumatic fever (ARF) and subsequent rheumatic heart disease (RHD).
Roadmap to incorporating group A Streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease
Improving primary prevention of acute rheumatic fever in Australia: consensus primary care priorities identified through an eDelphi process
To establish the priorities of primary care providers to improve assessment and treatment of skin sores and sore throats among Aboriginal and Torres Strait Islander people at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).
Rheumatic Heart Disease Control Programs, Registers, and Access to Care
Rheumatic heart disease (RHD) control programs have been recommended by the World Health Organization as the mainstay of reducing the burden of RHD for nearly half a century. Programs should be structured around a disease register of people living with RHD and to support delivery of secondary prophylaxis.
A community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia
In Australia’s north, Aboriginal peoples live with world-high rates of rheumatic heart disease (RHD) and its precursor, acute rheumatic fever (ARF); driven by social and environmental determinants of health. We undertook a program of work to strengthen RHD primordial and primary prevention using a model addressing six domains: housing and environmental support, community awareness and empowerment, health literacy, health and education service integration, health navigation and health provider education.
Improving the well-being for young people living with rheumatic heart disease: A peer support pilot program through Danila Dilba Health Service
Aboriginal and Torres Strait Islander peoples in Australia have an inequitable burden of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), concentrated among young people and necessitating ongoing medical care during adolescence. There is an unmet need for improved well-being and support for these young people to complement current biomedical management.
Protocol for the systematic review of the epidemiology of superficial Streptococcal A infections (skin and throat) in Australia
We have produced a protocol for the comprehensive systematic review of the current literature around superficial group A Streptococcal infections in Australia.
Formative evaluation of a community-based approach to reduce the incidence of Strep A infections and acute rheumatic fever
We explore the acceptability of a novel, outreached-based approach to improve primary and primordial prevention of Strep A skin sores, sore throats and acute rheumatic fever in remote Aboriginal communities. A comprehensive prevention program delivered by trained Aboriginal Community Workers was evaluated using approximately fortnightly household surveys about health and housing and clinical records.
Primary prevention of acute rheumatic fever
Acute rheumatic fever (ARF) is an abnormal immune reaction following Streptococcus pyogenes (Strep A) infection of the throat, and likely the skin. Primary prevention is the prompt and appropriate antibiotic treatment of Strep A infection, and it can reduce the risk of developing ARF and subsequent rheumatic heart disease.
Structured review of primary interventions to reduce group A streptococcal infections, acute rheumatic fever and rheumatic heart disease
Rheumatic heart disease (RHD) is a large, preventable, global public health burden. In New Zealand (NZ), acute rheumatic fever (ARF) and RHD rates are highest for Māori and Pacific children. This structured review explores the evidence for primary prevention interventions to diagnose and effectively treat group A Streptococcus (GAS) pharyngitis and skin infections to reduce rates of ARF and RHD.
Modes of transmission and attack rates of group A Streptococcal infection: a protocol for a systematic review and meta-analysis
Group A Streptococcus (Strep A) is an important cause of mortality and morbidity globally. This bacterium is responsible for a range of different infections and post-infectious sequelae. Summarising the current knowledge of Strep A transmission to humans will address gaps in the evidence and inform prevention and control strategies. The objective of this study is to evaluate the modes of transmission and attack rates of group A streptococcal infection in human populations.
Ending rheumatic heart disease in Australia: the evidence for a new approach
The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031 (the Endgame Strategy) is the blueprint to eliminate rheumatic heart disease (RHD) in Australia by 2031. Aboriginal and Torres Strait Islander people live with one of the highest per capita burdens of RHD in the world.
Quality of benzathine penicillin G: A multinational cross-sectional study
Benzathine penicillin G (BPG) is used as first-line treatment for most forms of syphilis and as secondary prophylaxis against rheumatic heart disease (RHD). Perceptions that poor quality of BPG is linked to reported adverse effects and therapeutic failure may impact syphilis and RHD control programs. Clinical networks and web-based advertising were used to obtain vials of BPG from a wide range of countries.
Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection
Benzathine penicillin G has been used as monthly deep intramuscular (IM) injections since the 1950s for secondary prevention of acute rheumatic fever and rheumatic heart disease (RHD). Injection frequency and pain are major programmatic barriers for adherence, prompting calls for development of better long-acting penicillin preparations to prevent RHD.
Voices behind the statistics: A systematic literature review of the lived experience of rheumatic heart disease
This systematic review presents a critical, interpretive analysis of publications that include lived experiences of rheumatic heart disease
The end rheumatic heart disease in Australia study of epidemiology (ERASE) project: Data sources, case ascertainment and cohort profile
The ERASE Project has created an unprecedented linked administrative database on acute rheumatic fever and rheumatic heart disease in Australia
Availability and administration of benzathine penicillin G for the prevention of rheumatic fever in Africa: Report of the Working Group on Penicillin
Benzathine penicillin G availability should be addressed and African health workers’ knowledge and practices need to be augmented
Public health and economic perspectives on acute rheumatic fever and rheumatic heart disease
Efforts to eliminate ARF and RHD in Australia over the past decade have so far been unsuccessful, but this can change
Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis
These results indicate that anaphylaxis is not a major cause of adverse reactions to benzathine penicillin G
Call for a national sore throat guideline
Australia needs a single national pharyngitis guideline to assist in providing rational, consistent and timely antibiotic treatment to patients at high risk of ARF
Time to tackle rheumatic heart disease: Data needed to drive global policy dialogues
This report provides an update on the contemporary global and regional policy landscapes relevant to rheumatic heart disease
Lessons learned in the development of sustained release penicillin drug delivery systems for the prophylactic treatment of rheumatic heart disease (RHD)
The current prophylactic treatment to prevent rheumatic heart disease requires four-weekly intramuscular injection of a suspension of the poorly soluble benzathine salt form of penicillin G (BPG) often for more than 10 years. In seeking to reduce the frequency of administration to improve adherence, biodegradable polymer matrices have been investigated.
Rheumatic heart disease: infectious disease origin, chronic care approach.
Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings.
The rationale for action to end new cases of rheumatic heart disease in Australia
The choice of RHD is telling: the disease is a marker of inequality, a novel lens for considering health systems and a feasible target for disease control.
A Comprehensive Needs Assessment Tool for Planning Rheumatic Heart Disease Control Programs in Limited Resource Settings
RHD is an important cause of disability and death in low- and middle-income countries.
The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of Rheumatic Heart Disease
As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts.
Rheumatic heart disease across the Western Pacific: not just a Pacific Island problem
We aimed to review RHD burden in Western Pacific Region outside Oceania to identify countries with high RHD burden
Preliminary consultation on preferred product characteristics of benzathine penicillin G for secondary prophylaxis of rheumatic fever
A sample target product profile for reformulated benzathine penicillin G is presented
Myositis complicating benzathine penicillin-G injection in a case of rheumatic heart disease
A 7-year old boy developed myositis secondary to intramuscular injection of benzathine penicillin-G in the context of secondary prophylaxis for RF
Supply of benzathine penicillin G: the 20-year experience in Australia
Reliable supplies of BPG are essential for delivering the recommended schedule of secondary prophylaxis for people living with RHD.
Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort
To describe the pattern of RHD occurrence in a sample of presenting cases from an occupational cohort in Papua Province, Indonesia.
Treating trade: the case for clinical engagement with regional trade agreements
The global burden of non-communicable diseases (NCDs) continues to grow. Although developing settings face fastest growth in incidence, no country is exempt.
Evolution, Evidence and Effect of Secondary Prophylaxis Against Rheumatic Fever
The association between group A streptococcal infection and rheumatic fever (RF) was established in the early 20th century.
The 5 × 5 path toward rheumatic heart disease control: Outcomes from the third rheumatic heart disease forum
This editorial viewpoint regarding the outcomes from the third global Rheumatic Heart Disease Forum intends to carry forward dialogue & engage new...
Rheumatic heart disease: Tools for implementing programmes
This article discusses the World Health Organization program for monitoring & managing rheumatic heart disease.
Big data in global health: Improving health in low- and middle-income countries
Over the last decade, a massive increase in data collection and analysis has occurred in many fields.
The case for global investment in rheumatic heart-disease control
The review built a case for extending simple and cost–effective measures to all countries. Had these recommendations been put into action, significant...
Prevention of rheumatic fever and heart disease: Nepalese experience
Historically, many young people suffered severe valvular disease and died awaiting heart valve replacement.
A conceptual framework for comprehensive rheumatic heart disease control programs
The World Health Organization, World Heart Federation, and other organizations recommend comprehensive control programs for rheumatic fever (RF) and...
Benzathine penicillin G for the management of RHD: Concerns about quality and access, and opportunities for intervention and improvement
Benzathine penicillin G is an important antibiotic for the treatment and prevention of group A streptococcal infections associated with rheumatic fever and...
The second rheumatic heart disease forum report
Building on the foundation of the first RHD forum, over 150 interested participants met to discuss critical issues on the RHD landscape.
Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease
In the 21st century, rheumatic fever (RF) and rheumatic heart disease (RHD) are neglected diseases of marginalized communities.