Rheumatic fever

Rheumatic fever is a serious illness that affects the valves of the heart. It mainly affects children or teenagers, after a specific type of sore throat called Group A streptococcal (GAS) infection.

In New Zealand we have much higher rates of rheumatic fever than most other developed countries, particularly amongst Maori and Pacific children. This is a major concern because rheumatic fever can cause permanent damage to a child’s heart valves – rheumatic heart disease. Rheumatic fever is preventable if all children or teenagers with a strep sore throat are treated.

Key points

  1. An untreated sore throat (‘strep throat’) can lead to rheumatic fever.
  2. If a child complains of a sore throat make sure they are checked by a doctor.
  3. If a ‘strep throat’ is diagnosed, the doctor will usually prescribe a 10 day course of antibiotics.
  4. It is important to complete the whole 10 day course to prevent rheumatic fever from developing.
  5. Groups at much higher risk of rheumatic fever include: Maori and Pacific children; families living in a crowded house; children age 5 - 19 year old growing up in high risk areas such as Northland, West and South Auckland, Bay of Plenty, Tairawhiti, Hawke's Bay and Porirua.


Child sore throat examination

In a small group of children or teenagers who get a strep sore throat, an autoimmune response (where the body attacks its own tissues) is triggered. This can then affect the heart, brain and skin which can become inflamed and swollen. Regular antibiotics are usually needed for some years afterwards to stop the disease coming back.


Rheumatic fever often starts with a sore throat, caused by a bacteria known as streptococcal infection. A few weeks later the following symptoms may develop:

  • sore or swollen joints
  • a skin rash
  • fever
  • stomach pain
  • jerky movements.

Although these symptoms may disappear, the heart valves may be permanently damaged. This is called rheumatic heart disease (RHD).


While the symptoms of rheumatic fever may disappear on their own, the inflammation can cause rheumatic heart disease, where there is scarring of the heart valves.

  • People with rheumatic heart disease need monthly penicillin injections for 10 or more years to prevent getting rheumatic fever again which would cause more damage.
  • They need regular specialist care and may need heart valve replacement surgery at some stage.
  • Even with treatments and surgery, rheumatic heart disease can still cause premature death – so it is very important to do apply all measures to prevent this disease affecting more children.
  • Whenever you have any dental or medical treatment, make sure the team know you have had rheumatic fever as you need prophylactic antibiotics. (Advice to prevent Infective Endocarditis – Heart Foundation NZ).

Learn more

Why Sore Throats Matter Health Promotion Agency
Rheumatic Fever Prevention Programme NZ Ministry of Health
It starts with a sore throat  East Bays Courier, Auckland, 7 August 13
NZ children get better start to life  NZ Government Press Release, 8 July 2013
Budget 2013: Additional $21.3m to fight rheumatic fever NZ Government Press Release, 21 May 2013 

Credits: Credits: written by Health Navigator. Last reviewed: 18 Jan 2015