This paper documents the ongoing high prevalence of rheumatic fever among the indigenous Māori and Pacific Island New Zealanders and the rise in ethnic disparities in the past decade. The introduction of secondary penicillin prophylaxis with 28-day intramuscular benzathine penicillin has had great success in disease control, with high penicillin delivery rates and low recurrence rates. A landmark study for primary prevention of acute rheumatic fever for group A streptococcal pharyngitis was published in 2009. New Zealand has helped establish the role of echocardiography in acute rheumatic fever, with subclinical carditis incorporated into guidelines as a major criterion of rheumatic fever in high prevalence regions. The rates of mitral valve repair for rheumatic heart disease (RHD) currently exceed 90% in the children’s cardiac unit but remain low in adult cardiac units in New Zealand. This is particularly relevant to women of childbearing age; New Zealand data reveal poor pregnancy outcomes for mothers with prosthetic valves on warfarin. New initiatives to prevent severe RHD include screening of schoolaged children with portable echocardiography. The prevalence of definite RHD was 2.4% in a large cohort of socially disadvantaged children in South Auckland during 2007–2008. Cost-benefit models of screening are needed. Ongoing research involves international consensus standardisation of RHD patterns, and the need to define the natural history of subclinical RHD.
