Rheumatic Fever

Estimated Duration: 
1 hour

Rheumatic fever is an autoimmune response to Group A Streptococcus (GAS) infection of the upper respiratory tract. The autoimmune response may result in carditis or inflammation of the mitral and/or aortic valves. When the inflammation leads to permanent damage of the valves the individual has rheumatic heart disease (RHD).

Acute rheumatic fever (ARF) has been shown to develop in approximately one to three percent of those in an epidemic situation of untreated exudative pharyngitis and/or a culture positive for GAS. Following infection there is a latent period of approximately three weeks before the symptoms of ARF begin. By the time the symptoms develop, the infecting strain of GAS has usually been eradicated by the host immune response.

Recurrences of rheumatic fever are likely in the absence of preventative measures and may cause further cardiac valve and muscle damage, leading to heart failure, strokes and premature death. Bacterial endocarditis is also a complication. For this reason, prevention of recurrences, and therefore rheumatic heart disease prevention, with intramuscular penicillin is both effective and highly cost-effective.

The highest documented rates in the world of acute rheumatic fever and RHD are in Māori and Pacific people in New Zealand, Aboriginal Australians and those in Pacific Island nations. As well as higher rates of initial ARF incidence, Māori and Pacific people also have the highest rates of ARF recurrence. The high rates of RHD in New Zealand are a significant cause of premature death.

Approximately 80% of the cases in New Zealand are in young people aged below 15 years. 

The North Island has a higher incidence of rheumatic fever than the South Island. Socio-economic factors such as poor housing, overcrowding, limited access to health care and lack of knowledge around sore throat management are well documented risk factors.

This short course will cover the diagnosis, management and secondary prevention of acute rheumatic fever.

Appropriate identification and antibiotic treatment of sore throats in high risk populations will usually eliminate group A streptococcus and prevent individual cases of acute rheumatic fever. Sore throat management (primary prevention) is covered in the short course Sore throat management in primary care

Learning objectives

  • Know the clinical features of acute rheumatic fever.
  • Understand the principles of the initial management of acute rheumatic fever.
  • Know the secondary prevention required for acute rheumatic fever.
  • Be aware of strategies to improve the adherence of secondary prevention.


Following the course you will find a short quiz designed to help consolidate your learning. When you complete the quiz please hit the 'submit' button to receive your certificate. 


This material was written by Sophie Adamson, Public Health Nurse and updated by Dr Karen Falloon PhD, MBChB, FRNZCGP for the Goodfellow Unit (2017).

The material is presented by the Goodfellow Unit (GFU),  an accredited continuing medical education/ continuing professional development (CME/CPD) provider for the Royal New Zealand College of General Practitioners and functions under a tripartite agreement between the Goodfellow Foundation, the College and the University of Auckland. The Unit is located within the Department of General Practice and Primary Health Care.


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