About rheumatic fever


Sore throats need to be checked

Rheumatic fever starts with a sore throat that is known as ‘strep throat’ – a throat infection caused by a bacteria called Group A Streptococcus.

Most sore throats get better on their own after about four days. But if strep throat is not treated with antibiotics it can cause rheumatic fever in at-risk children and young people. All sore throats in Māori and Pacific children and young people (aged 4–19 years) who are living in some parts of the North Island need to be checked.

If your child has strep throat, they’ll be given oral antibiotics for 10 days or a one-off penicillin injection to clear up the infection. It’s important to take the oral antibiotics for the full 10 days, even if they are feeling better. 

About rheumatic fever

Rheumatic fever is an autoimmune disease. It happens when your child’s immune system makes a mistake and attacks other parts of your child’s body, as well as the strep throat germs.

Most strep throats get better and don't lead to rheumatic fever. However, in a small number of people, an untreated strep throat develops into rheumatic fever, where their heart, joints (elbows and knees), brain and skin become inflamed and swollen.

A strep throat infection can lead to rheumatic fever, even if it's the first time or a one-off. The risk of getting rheumatic fever gets higher when someone has repeated untreated strep throat infections.  

While the symptoms of rheumatic fever may disappear on their own, the inflammation from even one rheumatic fever attack could develop into rheumatic heart disease, where there is scarring of the heart valves. This is serious. But almost all cases of rheumatic fever, rheumatic heart disease and associated deaths are preventable.

If your child has rheumatic fever

If your child develops rheumatic fever they will need a lot of bed rest and time off school. They’ll need to stay in hospital for weeks, where they will have examinations and blood tests to check their condition.

Rheumatic fever can affect your child’s life, making it more difficult for them to play sport or do other activities as they will have less energy.

Rheumatic heart disease

If your child’s rheumatic fever develops into rheumatic heart disease, it could cause serious heart problems, damaging your child’s heart forever. Your child may need heart surgery.


Rheumatic fever usually starts 1–5 weeks after your child has had strep throat.

Your child may develop:

  • sore and swollen joints (knees, elbows, ankles and wrists). Joints may feel hot as well; different joints may be sore on different days
  • an ongoing fever that lasts a few days
  • rash over the elbows, wrists, knees, ankles, and spine
  • small lumps under the skin
  • unusual jerky movements of hands, feet, tongue and face.

If your child has these symptoms or signs take them to the doctor or nurse straight away to get them checked.

They may also have:

  • a fever at or greater than 38° C
  • stomach pains
  • weight loss
  • extreme tiredness.

While the symptoms of rheumatic fever may disappear on their own, the inflammation caused by one rheumatic fever attack could develop into rheumatic heart disease where there is scarring of the heart valves and your child may need heart surgery. Rheumatic heart disease can be life threatening and can damage your child’s heart forever.

Anyone suspected to have rheumatic fever should be admitted to hospital for a thorough assessment. 

The hospital will do some tests to confirm whether your child has rheumatic fever or not. The tests may include a blood test and ECG or echocardiogram.


Because rheumatic fever starts with a sore throat, it’s important that your child’s sore throats get checked, especially if you live in Northland, Auckland, around Rotorua and Taupo, Waikato, the Bay of Plenty, Gisborne and the East Coast, Hawke’s Bay, Wellington or the Hutt Valley.

If your child is Māori or Pacific, aged between 4 and 19 years and has a sore throat, please get it checked straight away.

If your child has strep throat, they’ll be given antibiotics to clear up the infection before it can develop into rheumatic fever.

Where to get your child checked

There are lots of places you can get a sore throat checked.

  • You can go to your normal doctor or nurse. You may have to pay a fee; you can phone ahead to check. Let the receptionist know you have a child with a sore throat, just in case they have nurses available to respond quickly.
  • Your child’s school may have a free sore throat checking programme. Contact the school to find out.
  • You can also call Healthline on 0800 611 116 if you have any immediate concerns about your child’s sore throat.

If your child is given antibiotics, it’s important they take the full 10-day course, even if they feel better, to stop the sore throat turning into rheumatic fever.

Keep your home warm and dry

Keep your home warm and dry, and create as much space as possible to spread out around your home (rather than having to crowd in the same room).

Having more warm rooms and more sleeping spaces available means germs like strep throat are less likely to spread.

Living with

Rheumatic fever has long-lasting consequences. Repeated attacks of rheumatic fever can make rheumatic heart disease worse.

To prevent more attacks of rheumatic fever that can lead to rheumatic heart disease, it is important to stop further strep throat infections. This is done by giving your child penicillin injections every 28 days for at least 10 years.

Your child will also need:

  • time off school and not be able to exercise or play sports until their body has recovered.
  • regular dental checks and extra care of teeth and gums
  • an annual flu vaccination as well as the regular immunisations. The flu vaccine is free for people who have had a heart disease, such as rheumatic fever. Immunisations are important for people who have had rheumatic fever to prevent other illnesses which could affect their heart health.

Dentist visits

Looking after teeth and gums is very important if someone has had rheumatic fever because they are at risk of developing an infection on their heart valves. So please tell any oral health professional (dentist, dental nurse, hygienist or therapist) or other health carer that your child has had rheumatic fever.

Some children may need antibiotics before having dental work done to help reduce the chance of any infection reaching their heart during the dental procedure. Talk to your child’s doctor or dentist for more information.

A diet low in sugar is important to prevent tooth decay.

Make sure your child brushes their teeth twice a day with regular strength fluoride toothpaste – in the morning and before going to bed at night.

Dental care is free for under 18 year olds. For over 18 years, contact your local district health board for information on what support is available for getting regular dental care.